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International Journal of Pharmaceutical and Healthcare Marketing

“Infecting” those we care about: social network effects on body image


Aditi Grover, Jeffrey Foreman, Mardie Burckes-Miller,
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Aditi Grover, Jeffrey Foreman, Mardie Burckes-Miller, (2016) "“Infecting” those we care about: social
network effects on body image", International Journal of Pharmaceutical and Healthcare Marketing,
Vol. 10 Issue: 3, pp.323-338, https://doi.org/10.1108/IJPHM-09-2014-0052
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“Infecting” those we care Social


network
about: social network effects on effects
body image
Aditi Grover 323
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Department of Marketing, Oklahoma State University,


Received 24 September 2014
Tulsa, Oklahoma, USA Revised 17 March 2015
30 September 2015
Jeffrey Foreman Accepted 11 November 2015
Walker College of Business, Appalachian State University,
Boone, North Carolina, USA, and
Mardie Burckes-Miller
Health and Human Performance Department, Plymouth State University,
Plymouth, New Hampshire, USA

Abstract
Purpose – This paper aims to explore the forces at work that negatively influence the self-image
perceptions of young women, causing them to strive for an “ultra-thin” ideal.
Design/methodology/approach – Focus groups explore why and how perceived self-image
influences young women’s body and perceptions and, consequently, health. Thematic qualitative
analysis explores the realm of information and emotions involved with the thin-ideal.
Findings – Social contagion theory emerged with a significant impact caused by network influencers
and the spread of information and emotions within social networks forces that sustain the need to be
ultra-thin, even though there is abundant knowledge about adverse effects.
Research limitations/implications – Future research should address limitations involving
representativeness and generalizability.
Practical implications – Social marketing programs, including social media, should stress healthy
eating habits while focusing on the importance of the self and de-emphasizing the “thin-ideal” image.
Originality/value – Results will assist in developing more informed and effective prevention
programs, including social media campaigns, as preventative healthcare to reduce the risk of the spread
of eating disorders and promote psychological health of at-risk young adults.
Keywords Social network, Social media, Contagion, Grounded theory, Eating disorders,
Body image
Paper type Research paper

Introduction and background


According to the Center for Disease Control and Prevention (2014), eating disorders,
including anorexia, are a serious yet common problem among college students, International Journal of
Pharmaceutical and Healthcare
especially females. Eating disorders can be life-threatening and can lead to Marketing
cardiovascular problems and brain structure changes. In the current study, we seek to Vol. 10 No. 3, 2016
pp. 323-338
delve deeper into why and how self-image perceptions in this media-savvy world © Emerald Group Publishing Limited
1750-6123
influence young women’s perceptions of their bodies and, consequently, their health. DOI 10.1108/IJPHM-09-2014-0052
IJPHM Although obesity remains a major problem in the USA (Ogden et al., 2010) and may
10,3 be linked to diseases such as diabetes (Kay, 2007), it is also a common result of
mis-consumption of food that is a rampant problematic “lifestyle disease” (Narayana
et al., 2012, p. 2) across the USA. In this national context, one in three people are labeled
as obese (Kass et al., 2014). However, there exists another form of mis-consumption of
food, albeit on the other end of the spectrum. Females, especially those aged between 18
324 and 24 years, in their attempt to be in line with the media-promoted and society-revered
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but unrealistic thin image (Venkat and Ogden, 2002), can be afflicted with eating
disorders (Meng and Pan, 2012). Research has demonstrated that psychological factors
such as extreme emotions, self-perceptions and identity (Tantleff-Dunn et al., 2009),
family influences, and even genetics (Grogan, 1999; Pliner et al., 2007) are responsible for
the need to be thin that can result in anorexia, bulimia and binge eating, among other
disorders.
Aside from the effects on individuals, eating disorders have economic societal costs
such as adverse effects on productivity and absenteeism in the workplace (Dority et al.,
2010). According to the American Psychiatric Association, body image dissatisfaction is
an essential trigger for eating disorders, which might be more detrimental when those
who suffer from an eating disorder pay selective attention to messages (Cooper and
Fairburn, 1993), which in turn could increase the risk of eating disorder pathology. Even
though extant research has identified the key factors triggering the need for consuming
less than what is appropriate in an attempt to being thin, we are not aware of any
research that has identified the factors that feed into the identified triggers. Through
this research, we seek to understand what sustains these triggering effects even when
there is knowledge of the detrimental effects of being ultra-thin.
With this perspective, we strive to provide a better understanding of young women to
capture the multi-faceted relationship(s) within a social environment to examine the
deep and intense need to be ultra-thin. We believe that results of this study can assist in
developing more informed and effective prevention programs to reduce not only the risk
of the spread of eating disorders but also in promoting psychological health which feeds
on a positive sense of self.

The thin ideal and body image: what does research say?
In addition to research on previously mentioned psychological, self-perception and
genetic factors that affect the need to be thin, social factors have been the subject of
much previous research. Specifically, the “thin-ideal”, an internalized standard that
women may set for themselves concerning their personal values about size and weight,
appearance and the accompanying identity to which they strive to live up to (Ogden,
1995), is the research base this study builds upon. Previous research has shown media
content to be a factor in body image and appearance anxiety because of the thin-ideal
(Groesz et al., 2002). The prevalence of thin female models has been confirmed as highly
influential to young women, resulting in problematic issues, involving self-esteem, body
image, anorexia, bulimia and depression as related to the this ideal (Becker and
Hamburg, 1996; Harrison and Cantor, 1997), whereas undergraduate females comparing
themselves with images of thin female models had decreased satisfaction of their own
appearance and incorporated the thin-ideal to a greater extent (Engeln-Maddox, 2005)
with body shame and appearance anxiety (Monro and Huon, 2005).
Self-esteem is undeniably the life-giving force for all humans (Greenspan, 2007). Social
Among different factors that influence one’s self-esteem, dissatisfaction with one’s body network
has a tremendous impact on one’s self-image (Krishen and Worthen, 2011), which in turn
can lead to addictions such as over-exercising, smoking (Grogan, 2006), depression and
effects
eating disorders (Stice, 2002). Sypeck et al. (2006), among other researchers, have
reported the media as being largely responsible for this intense need among young
women to be ultra-thin. Interestingly, poor peer relationships with the opposite sex may 325
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be associated negative body image (Davison and McCabe, 2006). Perhaps, it is no


surprise that the average body mass index (BMI) of Miss America pageant participants
has been around a “normal” 22 in the 1920s to a low of 16.9 in the 2000s (Martin, 2010),
whereas the world standard for normal BMI lies between 18.5 and 24.5 (Burckes-Miller,
2010). Based on social comparison theories, if the impact of the intense need to be thin
among young women can be traced largely to the media and marketing communications
(D’Alessandro and Chitty, 2011; Smeesters et al., 2010), can public policy researchers
blame the media alone? What is the force that perpetuates what the media ignites?
Indeed, young women aspire to look like models and celebrities (Redmond, 2003) and in
the process learn to internalize the media-promoted thin-ideal (Stice, 2001), but what
adds fuel to this desire?

Study design
Using a grounded theory approach (Corbin and Strauss, 2008) to supplement extant
research outlining factors that influence the self-image perceptions in terms of female
body image, in coordination with the Eating Disorders Institute involved with the
International Association of Eating Disorders Professionals (iaedp), we conducted
semi-structured focus groups to address our research question. This qualitative method
is well suited to identify shared communications and meanings of the participants to
develop an understanding of the knowledge attitudes, beliefs and behaviors of the
female young adult population (Andreasen, 1995).

Field work
The focus group sessions were recorded on audiotape, and then the tapes were
transcribed by graduate students. Three undergraduate students were trained as coders
and took the transcriptions that were the culmination of student responses from the
focus groups. They developed an exhaustive list of categories and very specific codes by
isolating various phrases that the students had communicated when the moderator
introduced the issues of interest to the researchers in the study.
These focus groups were conducted over a period spanning from 2009 through 2011
at a regional university in New England with 15 female students in each group with a
total of 73 participants. The focus group presented a rich diversity in terms of age,
course of study, experiences and familial background. Participants were recruited
through the university newspaper/newsletter, flyers around campus and through
word-of-mouth. Focus groups were conducted in a quiet university setting, as
successfully tested and tried by Becker and Stice (2008). Female facilitators were
specifically trained to spearhead and administer the focus group discussions within a
secure and non-evaluative environment. All conversations during the focus groups were
audio-recorded and transcribed with the informed consent of the participants for
analysis.
IJPHM The focus groups, through dissonance reduction intervention, engaged participants
10,3 in an open conversation about the internalized thin-ideal values. Trained focus group
moderators had prior knowledge of the existing theory of the social environment
affecting young women in terms of the thin-ideal. Through a set of timed exercises
within the 3-4-h sessions, the participants were first studied to see if there was a “need to
be thin”. After this was overwhelmingly established, participants were encouraged to
326 take part in discussion to uncover the influences on the need to be thin. This started with
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general questions about body image, leading to the question of “what are the origins of
the thin ideal?”
The objective of the focus group was to understand the themes which underlie the
factors that promote the need for being ultra-thin. Initial questions asked of participants
were referenced from the Body Acceptance Class Manual (Stice et al., 2012). The focus
groups primarily involved open-ended questions and started off with warm-up
questions such as “Does anyone know where the thin ideal came from? In other words,
what are the origins of the thin ideal?” This led to a development of discussions where
every effort was made to understand the complexity of relationships by providing the
participants a rich opportunity to express, share and examine their thoughts and
feelings within a secure and friendly environment and without the influence of the
researchers. Following the advice of Andreasen (1995), we assessed the baseline levels of
knowledge and awareness about positive and negative aspects and perceptions of body
image. We sought to find out about possible difficulties, obstacles and social pressure
that influence attitudes and behaviors regarding the issue. None of the women in the
purposive sample currently reported to be suffering from an eating disorder.

Analysis of the information


A grounded theory technique was incorporated to analyze focus group content. We
collected, coded and analyzed transcripts of the focus group sessions. In the initial step
of the grounded approach, three undergraduate students transcribed audio recordings
of the focus groups. Next, with the help of the authors, the students analyzed the
transcripts of the focus group discussions. Following Corbin and Strauss (2008), the
researchers coded the data for themes and distinct categories. They started with open
coding in the first iteration to develop simple baseline codes for statements from the
transcripts. The first step was open coding of each excerpt from the transcripts by
evaluating, breaking down and categorizing the transcribed statements and passages.
The three undergraduate coders used MS Word and Excel to code each sentence and
statement by including the entire sentence or statement as applicable in every possible
category that was either established from previous research or developed and defined as
an emergent category. In the next step, categorized statements were related with each
other (Corbin and Strauss, 2008), whereas further iterations used constant comparison,
leading to the emergent results (Charmaz, 2006). After the coders developed the
extensive list of specific categories, they combined and refined the categories that
eventually emerged as the themes.
Throughout the process, they first coded independently and then compared notes to
examine for similarity. When differences emerged, they were considered in terms of
whether the difference was because of wording or perception. Issues were discussed
until consensus was achieved, and in cases where there was still a question lacking
consensus, the authors would decide the final coding result by resolving discrepancies
with an inter-rater reliability of approximately 95 per cent. This process refined the data Social
and ultimately determined patterns for development of emergent themes that coincided network
with existing theoretic literature. After the coders performed the rough coding into
highly specific categories, the authors approved the coded transcriptions along with a
effects
trained research assistant. Any disagreements were discussed until codes and
categories were finalized. Examples of specific categories are individual thoughts and
phrases the subjects mentioned, such as celebrity influence, friends and family support 327
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(positive and negative), online only friend influences and friends in person and online,
etc.

Results
Several themes evolved as result of the analysis described above. Initially, there was
some overlap in topics such as separation in the form of media influence or participants
in the social environment. However, as the constant comparison process among the
researchers continued, the resulting themes emerged:
• knowledge of the media that initiated and promoted body image;
• demonstration of internationalization and objectification of women;
• the other participants in the social environment; and
• the social contagion effect.

The first three identified categories have been extensively examined in prior literature.
What interested us even more was an understanding of the framework within which the
first three categories operated. This emerged as the fourth category/theme which was
found to be unique as it had not been discovered or explored in the previous research on
this topic. Implications and future research based on the focus group findings are
summarized in Table I.
One interesting theme that emerged was that of the real world and how the students
felt they were constantly being evaluated. Examples of transcripts varied, but several
statements were chosen as indicative of the types of conversations analyzed in the
transcripts. For example, subjects commented on the known subject of traditional media
influence. One participant added, “All of the media out there shows us some super
skinny models and it makes us think the way we are supposed to look if we want to look
our best”. Another subject specifically discussed social media influence:
Yeah it always seems like with your online profile there are so many others that you can be
immediately compared to. It’s like you my only have to worry about how you look in the real
world of face-to-face contact but you also have to worry about how you appear online. Like if
you post photos you only want to post the ones that make you look the best […] the skinniest
[…] that can actually be an advantage of social media […] like some people have even been
known to Photoshop their pictures but that can be a letdown when sometimes you feel like in
person you are not going to live up to that ideal image that you have tried to build on
Instagram.
Another participant commented:
Whenever I see my friends constantly posting pictures of themselves on Facebook, it
sometimes seems as if they are showing off […] I mean maybe it is just that they are sharing
pictures of their beach trips but it definitely has an effect on the way that I feel I should be. I
mean when you see a model on TV, it’s one thing because they are at a models but when you
IJPHM Focus group finding Implications Future research
10,3
(1) Knowledge of media-initiated Public advocacy marketers Investigate the relative
and media-promoted ultra- should consider positive strength of the
thin body image effects of communicating negative appeal of the
the negative side of the thin-ideal
328 thin-ideal
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(2) Internationalization and Policy makers should Explore media-induced


objectification of women consider the individual objectification
effects in light of the comparing individual
collective implications of and collective contexts
thin-ideal media on society
(3) Participants in the social Media messages are Measure the size and
environment (4) The social lessened exacerbated strength of the
contagion effect through social networks network effect with
respect to the thinness
Table I. and then utilize the
Focus group findings information to initiate
and implications a reversal effect

see your friends on Facebook looking all skinny in their bikini it has a greater effect because
you feel like that is what you really should look that good because it’s not all it’s not an actress
it’s actually someone you know even if you do not know them that well.
We found it interesting that the social networking of the thin-ideal came through
repeatedly in terms of students’ social media images of themselves. This relates to our
initial research goal of expanding the current knowledge base about the
communications involved with the young women in our study. In other words, students
felt that they not only had to deal with their self-image on face-to-face interactions but
also, more importantly, they seemed to really focus on their image as portrayed online.
This result helps to further understand what sustains triggering effects given the basis
of knowledge held by the participants about the detrimental effects of being ultra-thin
based on this ideal body image.
Thematic qualitative analysis revealed a significant impact caused by the spread of
information and emotions within social networks which comprised media, siblings,
power figures and, surprisingly, parents – particularly, the father. We found that the
social contagion theory emerged as an inherent framework revealing how social
network forces help sustain the need to be ultra-thin, even though there is abundant
knowledge among participants about the adverse effects of being extremely thin and
also about the detrimental impact of network influencers. We further explain the social
contagion theory later in this paper. We propose to utilize the strength of these networks
with implementation of social marketing programs to help reverse the effects and to
spread the “healthy-ideal” in efforts to further advance preventative healthcare.

Discussion
By examining the deep and intense need to be ultra-thin, in our research, to better
understand young women in their multi-faceted relationship(s) within a social
environment, we were able to produce some relevant and meaningful results. Although
our initial goal was not fully attained, we have captured what we believe are some Social
important results that will provide a foundation for taking steps to make a positive network
difference in the progress of stakeholders to be proactive about lessening the negative
effects of the thin-ideal. Following is a synopsis of what we have contributed in this
effects
research.

Knowledge of media-initiated and media-promoted ultra-thin body image


329
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In support of prior research, the participants confirmed their knowledge on the


association of poor health with the ultra-thin-ideal promoted by media. Participants
recognized the “games media plays” to promote an ultra-thin body image to promote the
sales of products such as make-up, clothing, diet pills and supplements. The role of
the media and the fashion industry emerged vividly in the discussions among the
participants. This is in congruence with existing literature which demonstrates that
body dissatisfaction does indeed reduce when females view media-promoted images of
ultra-thin women (Thompson and Stice, 2001; Groesz et al., 2002). One participant of the
study stated, “I do not like to read magazines because most of them make me feel bad
about myself”.
Although the discussion on the media emphasized on the way in which media
sources can “manipulate” individuals into buying products and brands that can assist in
achieving the ideal thin image, the participants were candid in expressing their own
fascination with body image in terms of spending on beauty magazines, diet drinks,
supplements and cosmetics. Even though the approximate dollar amount spent per
month on the above items varied, the majority of the focus group participants
recognized that they noticed other women’s bodies and compared themselves with
others almost all the time.

Demonstration of internationalization and objectification of women


There is mounting evidence of the need for young women to lose weight to gain the
attention of others and approval from their girlfriends in an attempt to boost
self-confidence. This trend is known to start in adolescence (Story et al., 1995). Various
exercises that comprised the focus groups demonstrated that the women were well
aware of the impact of media on their body image. In fact, an exercise which required
listing of the body parts involved with body image resulted in all the detailed description
of aesthetic shape and association of feminine attributes. We discovered participants not
only spend a lot of time in front of the mirror critiquing themselves but also look at their
own image on other “reflective surfaces” throughout the day. This perhaps represents
well the extent to which women internalize the “perfect socially desired” images.
Moreover, the impact of internationalization of the ultra-thin body image was so strong
that one of the participants who also worked as a massage therapist said that “almost
invariably when women come for body massage they apologize for how their body
looks”.

The other participants in the social environment


Surprisingly, other potent participants, such as parents and siblings, and power figures
(Tantleff-Dunn et al., 2009), such as superiors at work, and even professionals, such as
doctors, emerged in the focus group discussions. Even though prior research has
established the critical role played by family influencing eating habits as far was weight
loss efforts (Walsh and Nelson, 2010) and body image such as absence or presence of a
IJPHM loving child-parent relationship in affecting a young female’s body image (Hoeppner,
10,3 2000), the current study helped underscore the behavioral and emotional repercussions
that family can have on one’s body image. For example, a 21-year participant remarked,
“Knowing that my parents are currently on a diet and that in about four weeks, I will be
living at home and will be encouraged to participate”, which illustrated unsaid pressure
that is faced by some young women today. What also emerged interestingly in the
330 discussions was the potent and potentially detrimental impact of the remarks made by
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the father, and even the grandfather. One participant remarked, “My father had a direct
impact on me […] and how he made me feel as a child, especially, when he made remarks
on the bodies of other women in front of me”.
We found through focus group discussions that social media such as Facebook and
Twitter seems to have a great impact on individuals in the sample because of the vast
amount of information at hand. This is an important issue in line with prior research that
suggests social media websites are important channels for modern consumer
socialization (Wang et al., 2012). During our focus groups, we found that students are
able to connect with hundreds of others that they consider peers. Although a rather
novel concept, this is important for the understanding of the phenomena at hand
because much of the prior research has focused on traditional media influence. Prior
research has shown that individuals’ personalities may be somewhat accurately
portrayed by social networks (Ivcevic and Ambady, 2012), so this is an important
context for understanding body image conceptualizations.
The three themes that were reported above were an epitome of the research finding
that mere knowledge is not enough. All participants were well aware of the negative role
of media and its detrimental effect on women currently. Therefore, as our data collection
progressed, we encouraged women to explore deeply into all the factors “responsible”
for negative body image. We used probing questions and encouraged brainstorming
sessions to uncover variables that were more controllable than media alone because
with the wide-spread access and penetration of social media in our lives currently, the
power of media is likely to only grow stronger. Although prior research has shown that
social influences are in effect, our research was able to uncover the dramatic effects that
social media has on the subject’s body image perceptions. This makes sense considering
that conformity is an influence present in the realm of online socialization of consumers
(Wang et al., 2012). Discussions also led to the discovery of non-media influences in
participants’ immediate friend circles, making a case of how not only digital media and
images of celebrities and opinion leaders but also online peers, who may have no
physical contact, can have such a dramatic influence on body image. This finding is
expanded upon below.

The social contagion effect


An underlying framework operationalizing all the above-mentioned factors was a
network of social relationships in which the participants were embedded. A central
theme of the social contagion theory emerged – wherein the dire need and urgency to be
thin spread through observation, message transmission and modeled learning.
The contagion effect, which emerged in biological sciences in the 1800s, highlights
how the “crowd effect” can take precedence automatically over an individual’s attitudes
and behaviors. Gustave LeBon, Park and Blumer presented the social contagion theory
that asserts that people can make illogical and irrational choices when within a crowd,
whereas they normally may not do so outside the group. The theory therefore focuses on Social
the dynamics – social and psychological mechanisms – that may emerge when people network
come together in a group. Interestingly enough, the word “contagion” is an
old-fashioned term which refers to a rapidly spreading infection. This concept of rapid
effects
spread of something within a social framework lends the theory its name “social
contagion” (Locher, 2002).
According to this theory, when people within the confines of a group begin to focus 331
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on an event, idea or person, as this focus strengthens, the excitement builds and they
start to influence each other. Over time, they may lose self-consciousness and lose their
normal ability to think critically before they act. Under this situation, any idea offered by
a member of the group may be accepted and even revered, and the group can be reduced
to the level of its “lowest member”. In short, the collective behavior of the group occurs
within different set of stresses and may not see participation without the group process
(Christakis and Fowler, 2013). More recently, Fowler and Christakis have suggested that
obesity may spread in social networks in a quantifiable and discernable pattern that
depends on the nature of social ties (Christakis and Fowler, 2007). Although the
contagion effect represents a complexity of relationships and processes, in a broad
aspect, the theory represents the spread of an idea or thought from early adopters to
non-adopters within a social environment and given the unique characteristics of the
adopters vs the non-adopters. Research has shown that a diverse variety of behaviors
spread through human social networks. A nation-wide study – the Framingham Heart
Study – used network analyses to understand the root cause of the heart disease.
Following suit, Christakis and Fowler (2007) reported that good (and bad) behaviors and
attitudes, namely, obesity, loneliness and unhappiness, tend to pass from one friend to
another as if they were a “contagious” disease, making social contagion an important
area of inquiry.
Social comparison and enhancement theories mesh well with the predictions of the
social contagion theory where the motivation for people to maintain and strengthen
their self-esteem is a strong driver in people’s attitudes. The social comparison theory,
initially proposed by Festinger (1954), believes that individuals wish to acquire accurate
evaluations of the self. These evaluations are sought to gain self-knowledge (e.g.
evaluation, assessment and verification of the self) with an objective to maintain
self-esteem. The self-enhancement theory (Beauregard and Dunning, 1998) builds on the
propositions of the social comparison theory to underscore that these self-evaluations
serve an essential purpose for the individual for making upward or downward
comparisons (Gruder, 1971) with an objective of maintaining or enhancing (fortifying)
positive self-evaluations. This basic drive may heighten in socially threatening
situations. The social enhancement theory is not unique in that it underscores what
William James (1890) and contemporary researchers (Cialdini and Richardson, 1980;
Snyder et al., 1986) have reported that individuals wish to align themselves with positive
perceptions of the self. They tend to counter threats to their self-worth by enhancing and
stressing on other aspects of the self or even those of their friends and family.
The social contagion theory emerged even though the process of how “contagion”
may spread through the network may be at least in part be seen as an outcome of the
need to have positive self-evaluations, as suggested by the social comparison theory,
and the need to enhance these positive evaluations – by shooting down negative
evaluations or beliefs (e.g. ultra-thin is unhealthy) and focusing on the positive
IJPHM evaluations or beliefs (e.g. ultra-thin is chic), thereby enhancing one’s self-esteem. The
10,3 flexibility of the contagion theory suggests that although “negative” thoughts and
emotions may strengthen and prevent popular culture beliefs of “ultra-thin”,
introduction and strengthening an opposing belief can undo the negative impact of
unhealthy belief such as ultra-thin body image beliefs. Seminal work by Christakis and
Fowler (2007, 2009, 2010) has demonstrated how a behavior, affect or belief may spread
332 within a social network: The researchers use network modeling approaches to
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demonstrate how strong interpersonal influence within the network in diverse domains
such as drug use, happiness, loneliness, obesity, divorce, and sexuality to name a few.
Individuals may be influenced by the “crowd” without there being any individual
motivation.
Analyses of the data from the focus groups showed strong network effects that could
be considered “responsible” for the sustained need to be ultra-thin. Participants, as every
other human being, are embedded in a social network that influences the individual’s
attitudes and behaviors. This effect is perhaps stronger for younger individuals when
peer influence is likely to be the strongest. In fact, one participant reported strong
mutual feelings of peer influence feeling, though focus group participants would
“impact each other in a positive way”. There was a general “fear” in going back into the
real world, outside the room where the focus group was conducted when each
participant had to perhaps fend her way through the domination of the ultra-thin world
knowing that it was all such a “fake” illustration of life. Participants reported and agreed
that they felt that their friends were evaluating them at all times, and one participant
reported that “I am more myself with my hairdresser who I see just once a month”.

Reverse network effect


Although network effects can have a strong hold on individuals, we feel that the
negative effects of the network influence can be strengthened by initiating consistently
a reverse network effect (Hoeppner, 2000), where young females are encouraged to be
comfortable with their body size. We noticed that this emerged in the focus group
sessions with comments such as:
When we are here in the room, it’s all good, but when we go out to the world, there are such bad
influences, so if we can stay in touch and spread the word in a positive way, perhaps we can
help change attitudes.
For example, Christakis and Fowler (2007), in their obesity study, reported that there
existed clusters of obese people, and these clusters extended to three degrees of
separation where having a friend or a sibling who was obese increased the likelihood of
someone being obese themselves.
The focus group research presented strong evidence of similar network effects in the
need to be ultra-thin scenario. For example, familial effect on body image promoted body
dissatisfaction or self-esteem associated with body image. For example, one participant
reported that “small comments by my mother, father and sister, though unintentional,
hurt me”. Another participant said that “we are constantly comparing ourselves. I am
bigger in size than my mom and sister so that is something I am very aware of. When my
sister makes a comment about my weight, I become very aware of it”. The media effect
with the network was also prominent. Indicative of several participants’ comments, one
statement was, ” I try not to let it bother me much. I see others and sometimes wish I was
like them in terms of muscle tone, even though I am aware of how fake it is”. Another Social
participant said just “Ugh!” while discussing the role of media in the thin body image. network
Figure 1 summarizes the findings.
effects
Limitations and future research
Limitations were realized during the course of our study. The purposive and non-probability
sample is not conducive for generalizability and widespread representativeness in the 333
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population of interest. As this would be true of any qualitative study, we recommend that
future research including replication should address the issues we have uncovered. A
quantitative study involving a representative sample examining the contagion effect on
body image would be a logical step, moving forward. The research context of the USA is not
necessarily conducive across geographies, nationalities and cultures. Future research should
be conducted to address the global generalizability of the findings and to build the body of
knowledge of eating disorders globally.
The perspective of the opposite of the thin-ideal would be the perspective of the fat ideal.
As we did not collect data concerning the fat ideal we find it of interest to mention especially
in conjunction with the context of our US sample. Interestingly, in developed countries, lower
classes experience more obesity, and in developing countries, obesity is more prevalent for
higher social classes (Sobal and Stunkard, 1989). Therefore, future research should address
the issue of the opposite of the thin-ideal as a possible detrimental effect of the
discouragement of the thin-ideal. The fat-ideal should also be considered when data are
collected in samples from varying social classes across geographical contexts.
Another interesting area of future research made evident by our study involves
applying the social network theory and contagion effect to social media. During the
course of our study, it emerged that social network sites such as Facebook, Instagram
and Twitter were common mediums through which the contagion of the thin-ideal
inferences occurs. Research could be conducted by observing selected samples of social
media websites with company analysis to further explore some of the influences, in
particular, on popular social media sites. Future quantitative research should not only
seek to ascertain the relative proportions of influence each factor has on body image but

Demonstraon of
internaonalizaon and
objecficaon of women

Knowledge of
media iniated Body Image Reverse Network Effect
and promoted
body image

Figure 1.
Factors relevant in
perceptions and
beliefs about body
image
The social contagion effect
IJPHM also undertake the task of stating what types of methods and techniques could be used
10,3 on these mediums to discourage the spread of the ideal. It is suggested that future
research should quantify the different influences to work toward an overall model of
social contagion network effects on body image.
None of the women in the sample appeared to be suffering from an eating disorder. A
self-report study would be interesting including a sample in which varying types and
334 levels of eating disorders are present and accountable. In addition to further exploration
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of media-induced objectification in individual and collective contexts, future research


could investigate the relative strength of the negative appeal of the thin-ideal and
measure the size and strength of the network effect with respect to the thinness.
Information collected may then be used to initiate a reversal effect. A longitudinal
analysis could reveal the stages women go through when various influences contribute
to eating disorders. An interesting aspect of the study would be to have record of
Facebook, Twitter and Instagram, conversations of women who are in the at-risk age
group as they may become afflicted with an eating disorder. This could be beneficial, as
individuals may already be “invested” in their online social networks. We propose that
training participants in a new way of thinking can initiate a positive change: we did see
strong, optimistic response from participants in trying to make a positive impact
through spreading the message of there being no need to constantly run after the
ultra-thin image. In fact, one participant stated that “this program makes me want to
focus more on just being happy and healthy, and focusing on my positive characteristics
and then making them feel the same”.

Conclusions
Although prior research has reported the media as being the culprit in promoting an
unhealthy self-image perception and the associated quest for ultra-thinness, it is not
clear why the media has such a hold on people. In an effort to understand the underlying
processes or factors that promote the spread of eating disorders given the established
media effects, we propose that because of our findings of social contagion and social
networking as a facilitator of the communications about the this ideal, marketing
programs (Macera, 2010) should stress healthy eating habits while focusing on the
importance of the self and de-emphasizing the “thin-ideal” image promoted by media,
friends, family and power figures in an individual’s network. A thorough analysis of our
focus group data indicates that network effects, including social networks, are critical in
the spread of not only thoughts but also emotions that in turn promote the spread of
eating disorders in an effort to keep up with the Joneses in the “body image” world. This
result ties in to the emergent theme we discovered in terms of the social contagion effect.
Thus, even though the network phenomenon may be said to be largely triggered by the
media – both traditional and online – it appears to be strongly promoted by social media
involving friends, siblings, power figures and, surprisingly, parents too.
This information is an important component in the body of knowledge for
preventative healthcare in terms of eating disorders. Future research should build on the
basis of our implications to better understand the specific influence and prominence of
media with a focus on social networks to understand the different relative impact and
assorted ways in which varying media play a role in affecting young women in their
perceptions of body image.
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Further reading
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everyone else is doing it too: social network effects on divorce in a longitudinal sample”,
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use in adolescent social networks”, PloS One, Vol. 5, p. e9775.
IJPHM About the authors
Aditi Grover is Clinical Assistant Professor of Marketing at Oklahoma State University,
10,3 Oklahoma, USA. Prior to Oklahoma State, she has worked with Plymouth State University, NH.
She completed her PhD in Business (Marketing) at the University of Southern California in 2008.
She teaches marketing courses such as advertising and promotion management, consumer
behavior, marketing research and statistics. Her research involves exploration of consumer
attitudes and behaviors in varying life domains.
338 Jeffrey Foreman is an Assistant Professor of Marketing at the Walker College of Business,
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Appalachian State University, Boone, North Carolina, USA. He completed his PhD in Marketing at
the Robinson College of Business, Georgia State University, Atlanta, USA. His research interests
include marketing and public policy, as well as marketing strategy. Foreman has published in
numerous academic journals, including Journal of Business Research and the Journal of
Marketing Theory and Practice. Jeffrey Foreman is the corresponding author and can be contacted
at: foremanjr@appstate.edu
Mardie Burckes-Miller (EdD, Health Education) is a Professor of Health Education at
Plymouth State University in Plymouth, New Hampshire, where she is coordinator of the
Graduate Eating Disorders Institute. She teaches courses in health education and promotion at the
graduate and undergraduate levels. Her research interests are eating disorders/exercise addiction
prevention and counseling health education curriculum design in higher education. Mardie is a
frequent contributor to The Journal of Health Education, The Wellness Newsletter and the
Association of Worksite Health Promotion Newsletter.

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