Developmental Psychology © 2016 American Psychological Association

2016, Vol. 52, No. 3, 463– 474 0012-1649/16/$12.00 http://dx.doi.org/10.1037/dev0000095

Predictors and Health-Related Outcomes of Positive Body Image in

Adolescent Girls: A Prospective Study
Rachel Andrew, Marika Tiggemann, and Levina Clark
Flinders University

This study aimed to investigate prospective predictors and health-related outcomes of positive body
image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also
examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing
measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by
This document is copyrighted by the American Psychological Association or one of its allied publishers.

others (positively), self-objectification and social comparison (negatively), and body appreciation (pos-
itively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of
intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively
predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a
decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In
particular, girls with low body appreciation were more likely than girls with high body appreciation to
take up alcohol and cigarette use between time points. The results highlight body appreciation as an
important target for interventions designed to prevent or delay the uptake of alcohol and cigarette
consumption among girls. More broadly, they suggest that a positive body image can confer considerable
benefit for adolescent girls.

Keywords: adolescent girls, positive body image, body appreciation, prospective study, intuitive eating

Body image is recognized as a complex and multifaceted con- media messages depicting narrow beauty ideals (Avalos et al.,
struct that affects cognitive, behavioral, and emotional functioning 2005). Body appreciation has been shown to relate to adaptive
(Pruzinsky & Cash, 2002). Despite this broad conceptualization of psycho-social indicators of well-being including self-esteem, op-
body image, the majority of body image research has focused on timism (e.g., Avalos et al., 2005), and self-compassion (Albertson,
understanding and investigating negative aspects of body image Neff, & Dill-Shackleford, 2015; Wasylkiw, MacKinnon, & Ma-
(Tylka, 2011). Recently, however, there has been an increase in cLellan, 2012). In experimental studies, body appreciation has
examinations of positive and adaptive components of body image. been shown to protect against media-induced body image distur-
Positive body image is broadly described as the love, respect, and bance (Andrew, Tiggemann, & Clark, 2015a; Halliwell, 2013). To
acceptance of one’s appearance and physical function (Wood- date, the majority of research examining body appreciation has
Barcalow, Tylka, & Augustus-Horvath, 2010), and is distinct from used samples of adult women. Given that a considerable propor-
body satisfaction or a lack of negative body image (Tylka, 2011;
tion of adolescent girls report marked body dissatisfaction
Tylka & Wood-Barcalow, 2015a; Wood-Barcalow et al., 2010).
(Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999), it is im-
Qualitative studies have revealed common characteristics of peo-
portant that development of positive body image be investigated
ple with positive body image, including body acceptance, taking a
before adulthood.
functional view of the body, filtering appearance information in a
protective manner, and advocating a broad conceptualization of Adolescence is a time associated with significant social, phys-
beauty (Bailey, Gammage, van Ingen, & Ditor, 2015; Frisén & ical, and emotional change (Eccles, 1999). For girls, puberty
Holmqvist, 2010; Holmqvist & Frisén, 2012; McHugh, Coppola, brings about physical transitions in body composition, including
& Sabiston, 2014; Wood-Barcalow et al., 2010). increased fat deposits on areas such as the hips (Wertheim &
Positive body image is most commonly measured by the Body Paxton, 2011), that move appearance further away from cultural
Appreciation Scale (Avalos, Tylka, & Wood-Barcalow, 2005). definitions of beauty (e.g., thinness). Although the study of neg-
This scale assesses acceptance, respect and attention toward bodily ative body image in adolescent girls is extensive, as yet only a
needs, favorable opinions toward one’s body and rejection of small number of studies have investigated positive body image in
adolescents. In a sample of Spanish adolescent girls, body appre-
ciation correlated positively with self-esteem and adaptive coping,
and negatively with eating disorder symptomology (Jáuregui
This article was published Online First January 4, 2016.
Lobera & Bolaños Ríos, 2011; Lobera, Ríos, Fernández, & Casals
Rachel Andrew, Marika Tiggemann, and Levina Clark, School of Psy-
chology, Flinders University.
Elsa Sánchez, 2011). In Australian adolescent girls, positive rela-
Correspondence concerning this article should be addressed to Rachel tionships were found with perceived body acceptance by others
Andrew, School of Psychology, Flinders University, GPO Box 2100, Adelaide and intuitive eating (Andrew, Tiggemann, & Clark, 2015b). The
5001, South Australia, Australia. E-mail: [email protected] current study aims to expand upon these limited findings by

463
 464 ANDREW, TIGGEMANN, AND CLARK

investigating a range of potential predictors and outcomes of body a more rigorous test of proposed causal relationships within a
appreciation in adolescent girls. model.

Predictors of Body Appreciation

The Acceptance Model of Intuitive Eating
Beyond tests of the acceptance model of intuitive eating, other
Halliwell (2015) recently emphasized the importance of testing predictors of positive body image have not yet been explored in
theoretical models in advancing the study of positive body image. any age group. Understanding factors associated with body appre-
The acceptance model of intuitive eating (Avalos & Tylka, 2006) ciation is critical in identifying potential practical targets to en-
considers body appreciation to proximally predict an adaptive style hance body appreciation (Tylka, 2011). This may be particularly
of eating called intuitive eating. Intuitive eating involves attending important for adolescents who are still in the process of developing
to internal hunger and satiety cues to inform eating behavior, as and managing self-esteem, individuality and sense of identity
opposed to eating in response to external cues or restricting (Eccles, 1999). The current study explored three potential classes
intake (Tribole & Resch, 1995; Tylka, 2006). This model pro- of predictors. The first was perceived body acceptance by others
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

poses that perceived body acceptance by others indirectly pre- (as postulated in the acceptance model of intuitive eating). This has
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dicts body appreciation and intuitive eating through decreased been shown cross-sectionally to relate to body appreciation in both
self-objectification (the adoption of an observer’s perspective women (e.g., Avalos & Tylka, 2006) and adolescent girls (Andrew
of the body, Fredrickson & Roberts, 1997). People who feel et al., 2015b), but has not yet been investigated longitudinally. The
others accept their body should feel less need to monitor their second type of predictor was consumption of various forms of
outward appearance (Avalos & Tylka, 2006). Reduced self- media, and the third was engagement in different types of activi-
objectification is proposed to predict increased body apprecia- ties. Both of these aimed to assess the impact of girls’ engagement
tion and intuitive eating, as those who pay attention to body in everyday behaviors on body appreciation.
function should appreciate their body for its abilities, instead of In general, girls’ media consumption has been shown to have
focusing on perceived flaws, and should have more resources to negative effects on body image. For example, a recent meta-
attend to physical hunger cues (Avalos & Tylka, 2006; analysis concluded that there was a relationship between exposure
Fredrickson & Roberts, 1997). Body appreciation directly pre- to mass media emphasizing the thin-ideal and vulnerability to body
dicts intuitive eating because people with higher body appreci- image disturbances (Grabe, Ward, & Hyde, 2008). Thus, we pro-
ation should have a heightened awareness of bodily needs and pose that adolescent girls who consume less appearance-based
act with respect toward their body (Avalos & Tylka, 2006). media will show greater body appreciation, as a result of decreased
The acceptance model of intuitive eating has been tested and levels of exposure to messages emphasizing the importance of
confirmed cross-sectionally in undergraduate women (Avalos & appearance. Likewise, greater exposure to nonappearance media
Tylka, 2006), college athletes (Oh, Wiseman, Hendrickson, Phil- that highlight ability (e.g., cooking shows) or that engage girls
lips, & Hayden, 2012) and in young and middle-aged adult women intellectually (e.g., documentaries) may enhance body apprecia-
(Augustus-Horvath & Tylka, 2011). More recently the model was tion. In addition, Menzel and Levine (2011) have proposed that
shown to hold in a sample of Australian adolescent girls (Andrew engaging in embodying activities, that is, activities which involve
et al., 2015b). These authors also reported that reduced social a mind-body integration (Piran, 2001, 2002), is key to positive
appearance comparison was an additional (negative) mediator in body image. Accordingly, we propose that playing sports or other
the positive relationships between perceived body acceptance by physical activities that place emphasis on body function (e.g.,
others and both body appreciation and intuitive eating. Thus, their soccer) should enhance body appreciation. We also expected that
modified acceptance model of intuitive eating included both self- participating in hobbies and other engaging activities, such as
objectification and social appearance comparison as mediators playing a musical instrument, may also foster body appreciation
(Andrew et al., 2015b). because, as suggested by Halliwell (2015), such activities empha-
The current study sought to longitudinally examine the modified size one’s physical capabilities and the mind-body connection.
acceptance model of intuitive eating in adolescent girls, a group
undergoing a period of development associated with eating attitude Outcomes of Body Appreciation
formation (Graber, Brooks-Gunn, Paikoff, & Warren, 1994) and One facet of positive body image is investment in the care of the
heightened risk of disordered eating (Paxton et al., 1991). All body and its physical needs (Tylka, 2011, 2012), and thus, Tylka
previous tests of the acceptance model of intuitive eating have and Wood-Barcalow (2015a) have suggested that positive body
been limited to correlational designs. Correlational studies cannot image may be protective of physical health. To our knowledge,
confidently determine the direction of causality between variables. there have been only two studies, both correlational, investigating
For example, while the acceptance model postulates that body the health-related outcomes of body appreciation outside of intu-
appreciation leads to intuitive eating, the converse causal direction itive eating. In the first, Andrew, Tiggemann, and Clark (2014)
is also plausible. That is, engaging in an adaptive and intuitive found that body appreciation was positively associated with sun
eating style might lead to greater body appreciation. A minimum protection, skin screening, and seeking medical attention when
requirement for causality is temporal precedence (Menard, 1991). needed, and negatively related to weight-loss behavior in adult
This can be tested using longitudinal methodology by examining women. In the second, Gillen (2015) reported that body appreci-
whether a proposed cause (e.g., body appreciation) is temporally ation was positively correlated with intentions to protect skin from
antecedent to (occurs before) the proposed effect (e.g., intuitive sun damage and negatively related with dieting in young adult men
eating). Thus, the use of a longitudinal research design allows for and women.
 PREDICTORS AND OUTCOMES OF GIRLS’ POSITIVE BODY IMAGE 465

As yet, potential health outcomes of positive body image (other measures of body appreciation, self-objectification, social appear-
than intuitive eating) have not been examined in adolescents; nor ance comparison, and perceived body acceptance (in that order),
has there been any longitudinal study of health outcomes in any followed by health behaviors including intuitive eating, and gen-
age group. The adolescent period is associated with the develop- eral demographic information.
ment of personal autonomy (Eccles, 1999), including increased Body appreciation. Body appreciation was measured by the
choices around behaviors that impact on health. In addition, Body Appreciation Scale (BAS) of Avalos and colleagues (Avalos
healthy habits developed during this period can have benefits into et al., 2005). Participants rate 13 items (e.g., “Despite my flaws, I
adulthood (Aarts, Paulussen, & Schaalma, 1997). In the current accept my body for what it is”) on a 5-point scale ranging from
study, we examined a range of health behavior outcomes, both 1 ⫽ never to 5 ⫽ always. Items are averaged with higher scores
adaptive and harmful. The adaptive health behaviors included reflecting higher levels of body appreciation. The BAS has dem-
consumption of the recommended intake of fruit and vegetables, onstrated 3-week test–retest reliability (r ⫽ .90), construct and
sun protection, adequate sleep, and seeking medical attention. discriminant validity (Avalos et al., 2005), and has been shown to
Potentially harmful behaviors examined were dieting, consump- have high internal reliability (␣ ⫽ .88) in an adolescent sample
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

tion of takeaway food, and alcohol and cigarette use. (Lunde, 2013). For the present sample, internal reliability was high
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at both Time 1 (␣ ⫽ .93) and Time 2 (␣ ⫽ .94).

The Current Study Media consumption. A set of 11 items assessing media con-
sumption was constructed for the study. The first three questions
In summary, the current study sought to extend the understand- assessed magazine consumption. Participants were asked to rate
ing of both predictors and health outcomes of body appreciation in how often they read “Teen (e.g., Dolly),” “Fashion (e.g., Vogue),”
adolescent girls, using a longitudinal research design. The study and “Other magazines (e.g., Rolling Stone, Better Homes and
had three specific aims. The first aim was to longitudinally test the Gardens),” on a scale ranging from 1 ⫽ never to 5 ⫽ every time
modified acceptance model of intuitive eating (Andrew et al., an issue comes out. The remaining eight items were rated from 1 ⫽
2015b; Avalos & Tylka, 2006) in adolescent girls. The second aim never to 5 ⫽ all the time. The first two questions asked participants
was to explore prospective predictors of body appreciation in to rate how often they view “Fashion websites/blogs/online mate-
adolescent girls, in particular, perceived body acceptance by oth- rial,” and how often they use “Social media (e.g., Facebook).”
ers, consumption of appearance and nonappearance-based media, Finally, TV viewing was assessed with six items asking partici-
and engagement in sports and hobbies. The third aim was to pants to rate how often they watch “Soapies or dramas,” “Music
longitudinally examine a range of health-related outcomes of body television shows,” “Talent-based reality television (e.g., Top
appreciation, namely, dieting, fruit, vegetable and takeaway con- Model),” “Nontalent based reality television (e.g., Big Brother),”
sumption, sun protection, sleep, medical attention, and alcohol and “Cooking (e.g., Master Chef) or construction (e.g., The Block)
cigarette use. shows,” and “Information based shows (e.g., documentaries or the
news).” From these items, measures of appearance and nonappear-
Method ance media consumption were created. The measure of appearance
media summed items assessing consumption of teen magazines,
fashion magazines, fashion websites, social media, and watching
Participants
soapies, music TV, and talent and nontalent-based reality TV.
Participants were 298 girls recruited from five schools (two Internal reliability was acceptable (Time 1, ␣ ⫽ .70, Time 2, ␣ ⫽
coeducational public schools and three private single-sex schools) .73). The three items measuring nonappearance media (reading
in metropolitan South Australia. The girls were a subset of a larger other magazines, watching cooking or construction TV shows, and
cross-sectional study (Time 1, N ⫽ 400) investigating a model of watching information based TV) did not cohere together at Time 1
intuitive eating in girls (Andrew et al., 2015b). The retention rate (␣ ⫽ .48) or Time 2 (␣ ⫽ .47), and thus were examined separately.
was 74.5% at Time 2. The girls were in Years 8, 9, or 10 at Time Activities. Two types of activities were assessed with a mea-
1 and had a mean age of 14.03 years (SD ⫽ 0.88). At Time 2, 1 sure constructed for the study. Nine items addressed sports and
year later, the girls were in Years 9, 10, or 11 and had a mean age physical activities. These were walking, yoga/pilates, swimming,
of 15.02 years (SD ⫽ 0.85). Attrition was mostly because of running, bike riding, hiking, martial arts, dance, and organized
absenteeism or girls having left the school. Attrition analyses sports (e.g., soccer). Seven items addressed hobbies or other en-
showed that there were no significant differences between girls gaging activities: reading, playing a musical instrument, attending
who did and did not complete the Time 2 follow-up on any Time church, volunteering, belonging to a group/organization, doing
1 study variable. The sample was predominantly White (⬎85%). drama, and arts/crafts. Participants indicated whether or not they
The schools ranged in socioeconomic status, with Socio-Economic engaged in each activity, how many sessions per week they en-
Indexes for Areas (SEIFA; Australian Bureau of Statistics, 2011) gaged in that activity (frequency), and for how many minutes per
based on school postcodes ranging from decile 2 (low) to decile 8 session (duration). Time spent on each activity was calculated by
(high). multiplying each activity’s frequency by its duration. Time spent
engaged in physical activities was calculated by summing minutes
spent on each of the nine sporting and physical activities. Time
Measures
spent on hobbies was calculated by summing minutes spent on the
Participants completed a questionnaire at Time 1 and then again seven hobbies listed.
approximately 1 year later (Time 2). The questionnaire contained Body acceptance by others. Perceived body acceptance by
measures of activities and media consumption, followed by the key others was measured using the Body Acceptance by Others Scale
 466 ANDREW, TIGGEMANN, AND CLARK

(Avalos & Tylka, 2006). Participants rate items relating to percep- ever been on a diet to lose weight, on a scale ranging from 1 ⫽
tion of how accepting important others are of their weight and never to 5 ⫽ always.
shape on a 5-point scale ranging from 1 ⫽ never to 5 ⫽ always. Fruit, vegetable, and takeaway consumption. Girls re-
The original 10-item scale assessed body acceptance by family, sponded to three questions regarding their food intake. In Austra-
friends, dating partners, society, and the media. In the current lia, dietary guidelines recommend the consumption of two serves
study, these questions were asked in relation to family and friends. of fruit and five serves of vegetables daily (National Health and
The resulting scale had four items (e.g., “I’ve felt acceptance from Medical Research Council, 2013), with this quantity advertised
my family regarding my shape and/or weight”). Items were aver- widely through TV and print campaigns that aim to assist parents
aged with higher scores indicative of greater perceived body in increasing their children’s intake of fruit and vegetables (Com-
acceptance by others. The original measure has been shown to monwealth of Australia, 2008). The first question asked partici-
have good internal consistency (␣ ⫽ .91), 3-week test–retest pants to indicate (on average) how many days during the week
reliability (r ⫽ .85), and construct validity in college women (i.e., 0 to 7) they consume at least two serves of fruit. The second
(Avalos & Tylka, 2006). In the present sample, internal reliability question asked how many days (on average) they consume at least
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

was acceptable at Time 1 (␣ ⫽ .74) and Time 2 (␣ ⫽ .79). five serves of vegetables. The final question asked how many days
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Self-objectification. Self-objectification was measured by the in an average week participants consume a takeaway (i.e., “fast
Body Surveillance Subscale of the Objectified Body Conscious- food”) meal.
ness Scale (McKinley & Hyde, 1996). The subscale examines Sun protection. Sun protection was examined with five items
monitoring of one’s body and perceiving it in terms of appearance adopted from the Cancer Council Australia’s National Sun Pro-
as opposed to function (McKinley & Hyde, 1996). The scale tection Survey (see Dobbinson et al., 2008) used previously with
consists of eight items (e.g., “I rarely think about how I look”). an adult female sample (Andrew et al., 2014). These questions
Participants rate each item on a scale ranging from 1 ⫽ strongly examined specific behaviors such as wearing sunscreen and stay-
agree to 7 ⫽ strongly disagree, with a not applicable option coded ing in the shade during peak UV hours in summer. Participants
as missing. Scores are averaged and higher scores reflect higher rated how often they performed each sun protection behavior on a
self-objectification. This measure has been shown to be reliable 5-point scale ranging from 1 ⫽ never to 5 ⫽ always. The five
items were summed to create a total sun protection score (ranging
and valid in adults (McKinley & Hyde, 1996), and internally
from 5 to 25). Internal reliability for this scale was acceptable
consistent in a sample of Australian adolescent girls (␣ ⫽ .86,
(␣ ⫽ .70) at Time 1, and a little short of acceptable (␣ ⫽ .60)
Slater & Tiggemann, 2002). In the current study, internal reliabil-
at Time 2.
ity was acceptable at Time 1 (␣ ⫽ .79) and Time 2 (␣ ⫽ .84).
Alcohol consumption. Participants were asked how many
Social comparison. Social appearance comparison was as-
times they had ever consumed alcohol with a choice of five
sessed using the Physical Appearance Comparison Scale (Thomp-
responses ranging from 1 ⫽ zero to 5 ⫽ 10 or more. This question
son, Heinberg, & Tantleff-Dunn, 1991). Participants rate five
was considered the most appropriate assessment of alcohol con-
items (e.g., “In social situations, I sometimes compare my figure to
sumption for this sample, given that participants were under the
the figures of other people”) on a 5-point scale from 1 ⫽never to
age of legal alcohol consumption in South Australia (18 years old)
5 ⫽ always. This scale has demonstrated high 3-week test–retest
and legally should not have consumed any alcohol.
reliability (r ⫽ .78) in adolescent girls (Schutz, Paxton, & Cigarette smoking. Participants were asked how many ciga-
Wertheim, 2002), and was highly correlated with upward and rettes they had smoked in their lifetime with four possible re-
downward appearance comparison in college students (O’Brien et sponses 1 ⫽ none, 2 ⫽ 1 to 2, 3 ⫽ 2 to10, and 4 ⫽ 10 or more.
al., 2009). At Time 1, the internal reliability fell short of acceptable Because of the small number of participants who had ever smoked
(␣ ⫽ .66). Item-scale correlations indicated that low internal any cigarettes, responses were dichotomized to none or some
reliability was because of the one negatively worded item (Item 4), categories.
which has been previously reported in adolescent samples (Tigge- Weekly sleep. Participants were asked to indicate what time
mann & Miller, 2010). Therefore, Item 4 was removed from Time they fell asleep and wake up on an average day during the week
1 and Time 2 scales, and the remaining four items were summed and on the weekend. Weekly sleep was calculated by multiplying
with scores ranging from 4 to 20. The resulting internal reliability weekday sleep by five, and weekend sleep by two, and summing.
was acceptable at Time 1 (␣ ⫽ .80) and Time 2 (␣ ⫽ .81). Seeking medical attention. One question asked how often
Intuitive eating. Intuitive eating was measured with the Intu- participants go to a doctor when they feel ill, rated on a 5-point
itive Eating Scale for Adolescents (Dockendorff, Petrie, Greenleaf, scale ranging from 1 ⫽ never to 5 ⫽ always.
& Martin, 2012). This scale aims to assess unconditional permis- Demographics. The girls were asked to provide their age,
sion to eat, eating for physical rather than emotional reasons, and year level at school and ethnicity, and reported their weight and
awareness and trust in internal satiety and hunger cues. Seventeen height measurements.
items (e.g., “I trust my body to tell me how much to eat”) are rated
on a 5-point scale from 1 ⫽ strongly disagree to 5 ⫽ strongly
Procedure
agree. Scores are averaged with higher scores reflecting greater
intuitive eating. The scale has demonstrated validity (Dockendorff The protocol used in the current study was approved by the
et al., 2012). Internal reliability was acceptable at Time 1 (␣ ⫽ .80) relevant institutional research ethics board, the Department for
and Time 2 (␣ ⫽ .83) in the current sample. Education and Child Development Research Unit and the Catholic
Dieting behavior. Frequency of dieting was assessed with one Education Office. The Principal of each participating school was
question asking participants to rate the extent to which they have contacted for permission to take part in the study. After permission
 PREDICTORS AND OUTCOMES OF GIRLS’ POSITIVE BODY IMAGE 467

was granted, parental consent was obtained for both Time 1 and time. All correlations between Time 1 and Time 2 ranged from
Time 2 participation through a package sent home with each moderate to strong (r ⫽ .47 to r ⫽ .78).
eligible girl containing a Letter of Introduction, Information Sheet,
and Consent Form. Girls who were given parental consent also
Longitudinal Test of the Modified Acceptance Model
gave their own assent to participate on the day of data collection.
Participants completed both Time 1 and Time 2 questionnaires in of Intuitive Eating
normal class time in groups. At each school, girls were offered the Table 2 displays the correlations between variables contained
opportunity to enter into a raffle to win one of several $20 within the modified acceptance model of intuitive eating at Time
vouchers for a clothing store as a gesture of appreciation for their 1, at Time 2, and cross-lagged (between Time 1 and Time 2). As
time. can be seen, all variables were significantly correlated with each
other at all time points. In particular, in line with the modified
Results acceptance model, the cross-lagged correlations showed that per-
ceived body acceptance by others at Time 1 was negatively related
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

to Time 2 self-objectification and social comparison, and posi-

Preliminary Analysis
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tively related to Time 2 body appreciation and intuitive eating.

Data were examined for missing values and deviations from Time 1 self-objectification and social comparison were negatively
normality. There was only a small amount of missing data ranging related to Time 2 body appreciation and intuitive eating. Finally,
from 0% (sports and physical activities) to 2.68% (takeaway Time 1 body appreciation was positively related to Time 2 intui-
consumption), and no substitution was undertaken. All continuous tive eating.
variables were normally distributed, with low levels of skew (⬍3) The modified model of intuitive eating was examined using
and kurtosis (⬍10). longitudinal change regression models (Allison, 1990). Four re-
gression models were performed representing different steps in the
model. In each model, age and intuitive eating at Time 1 were
Changes Over Time
controlled for by being entered in Step 1. Model variables and their
Table 1 displays the means and SDs for all variables at Time 1 respective change scores were entered in Step 2. Time 2 intuitive
and Time 2. It can be seen that body appreciation increased eating was the outcome variable in all models. Results for the four
significantly over time. Perceived body acceptance by others, models are shown in Table 3, which presents the standardized
watching information based TV, alcohol consumption, and ciga- coefficients (␤s).
rette smoking also increased significantly. On the other hand, It can be seen that in Model 1, Time 1 perceived body accep-
appearance media consumption and weekly sleep decreased over tance by others predicted an increase in intuitive eating. In Model

Table 1
Mean and SDs, and t Values for Study Variables

Variable Time 1 Time 2 t value

Main variable
Body appreciation 3.39 (.80) 3.49 (.80) 2.84ⴱ
Predictors
Appearance media 25.24 (5.40) 24.00 (5.25) ⫺5.50ⴱⴱ
Nonappearance media
Nonfashion magazines 1.80 (.96) 1.86 (.97) .10
Cooking and construction TV 2.69 (1.04) 2.74 (1.08) .82
Information based television 2.63 (1.05) 2.76 (1.04) 2.30ⴱ
Activities
Sports and physical activity 483.73 (483.04) 515.44 (487.02) 1.17
Hobbies 380.89 (522.70) 370.03 (472.46) ⫺.37
Perceived body acceptance by others 4.04 (.84) 4.15 (.83) 2.65ⴱ
Self-objectification 4.54 (1.08) 4.52 (1.12) ⫺.16
Social comparison 12.19 (3.44) 11.98 (3.35) ⫺1.27
Outcomes
Intuitive eating 3.22 (.55) 3.20 (.57) ⫺.52
Dieting behavior 2.48 (1.44) 2.58 (1.38) 1.46
Fruit consumption 5.03 (1.88) 4.97 (1.78) ⫺.41
Vegetable consumption 3.56 (2.02) 3.44 (2.18) ⫺.65
Takeaway consumption 1.09 (1.05) 1.06 (1.13) ⫺.73
Sun protection 13.85 (3.93) 14.08 (3.51) 1.70
Alcohol consumption 1.68 (1.03) 2.20 (1.29) 7.81ⴱⴱ
Cigarette smoking 1.05 (.21) 1.12 (.33) 4.45ⴱⴱ
Weekly sleep (hours) 62.36 (6.24) 59.91 (6.83) ⫺6.41ⴱⴱ
Medical attention 3.29 (1.13) 3.26 (1.12) ⫺.55
ⴱ ⴱⴱ
p ⬍ .05. p ⬍ .001.
 468 ANDREW, TIGGEMANN, AND CLARK

Table 2 collectively entered. Body appreciation was the strongest (posi-

Correlations Within and Between Time for Modified Acceptance tive) predictor of subsequent intuitive eating, reducing the signif-
Model Variables icant effect of change in self-objectification to nonsignificance,
and decreasing the strength of the negative prediction by social
PBA SO SC BA IE comparison.
Within Time 1 Overall, these results provide prospective support for the mod-
Perceived body acceptance ified acceptance model of intuitive eating. Specifically, perceived
(PBA) — body acceptance by others and body appreciation predicted a
Self-objectification (SO) ⫺.19ⴱ — subsequent increase in intuitive eating, and social comparison and
Social comparison (SC) ⫺.23ⴱ .53ⴱ —
Body appreciation (BA) .44ⴱ ⫺.51ⴱ ⫺.49ⴱ — self-objectification predicted a decrease in intuitive eating over a
Intuitive eating (IE) .27ⴱ ⫺.39ⴱ ⫺.45ⴱ .48ⴱ — 1-year time period. The final model (Model 4) showed that body
Within Time 2 appreciation followed by social comparison were the strongest
Perceived body acceptance — prospective predictors of subsequent intuitive eating.
Self-objectification ⫺.23ⴱ —
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Social comparison ⫺.30ⴱ .70ⴱ —

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Body appreciation .49ⴱ ⫺.56ⴱ ⫺.54ⴱ — Predictors of Time 2 Body Appreciation

Intuitive eating .42ⴱ ⫺.45ⴱ ⫺.51ⴱ .56ⴱ —
Cross-lagged Table 4 displays the correlations between proposed predictors
Time 2 and body appreciation separately within Time 1 and Time 2, and
Time 1 between Time 1 predictors and Time 2 body appreciation. As can
Perceived body acceptance — ⫺.21ⴱ ⫺.25ⴱ .40ⴱ .32ⴱ be seen, at both time points, perceived body acceptance by others
Self-objectification — .46ⴱ ⫺.40ⴱ ⫺.30ⴱ was positively related to body appreciation. In addition, appear-
Social comparison — ⫺.42ⴱ ⫺.38ⴱ ance media was related negatively, and reading nonfashion mag-
Body appreciation — .40ⴱ
Intuitive eating — azines was related positively, to Time 1 body appreciation. Sports
ⴱ
participation was positively related to body appreciation at Time 2.
p ⬍ .001. The cross-lagged correlations showed a positive relationship be-
tween perceived body acceptance by others at Time 1 and body
2, which added Time 1 and change scores on self-objectification appreciation at Time 2. There was also a positive relationship
and social comparison to Model 1, lower initial social comparison between Time 1 reading of nonfashion magazines and body ap-
and decreased self-objectification, and social comparison from preciation at Time 2 (p ⫽ .050).
Time 1 to Time 2 predicted increased intuitive eating, with per- A series of hierarchical multiple regression analyses was con-
ceived body acceptance by others still a significant predictor. In ducted to test the temporal precedence of the proposed predictor
Model 3, Time 1 body appreciation and change in body appreci- variables to body appreciation. Temporal precedence occurs when
ation were added to variables in Model 1. Here, higher Time 1 one variable predicts change in another variable, while controlling
body appreciation and increased body appreciation predicted in- for initial levels of the outcome variable (Stice, 2002). For each
creased intuitive eating. The addition of body appreciation in regression, Time 1 body appreciation was entered in Step 1, and
Model 3 decreased the effect of perceived body acceptance by the proposed predictor entered in Step 2. Time 2 body appreciation
others to nonsignificance. In Model 4, all model variables were was the outcome variable. Analyses showed that perceived body
acceptance by others at Time 1 was the only proposed predictor to

Table 3
Results (Standardized Regression ␤ Coefficients) of Regression Table 4
of Change in Intuitive Eating on Perceived Body Acceptance by Correlations Within and Between Time for Predictor Variables
Others, Self-Objectification, Social Comparison, and and Body Appreciation
Body Appreciation
Cross-lagged: T1
Model 1 Model 2 Model 3 Model 4 Predictor variable Within T1 Within T2 predictor, T2 BA

Step 1 Perceived body acceptance

Age .03 .03 .03 .03 by others .44ⴱⴱⴱ .49ⴱⴱⴱ .40ⴱⴱⴱ
Intuitive eating T1 .61ⴱⴱ .63ⴱⴱ .61ⴱⴱ .63ⴱⴱ Appearance media ⫺.14ⴱⴱ ⫺.10 ⫺.07
Step 2 Nonappearance media
Perceived body Nonfashion magazines .12ⴱⴱ .09 .11ⴱ
acceptance T1 .17ⴱⴱ .11ⴱ .09 .07 Cooking and
Self-objectification T1 ⫺.08 ⫺.02 construction TV .06 .07 .06
⌬ Self-objectification ⫺.16ⴱ ⫺.07 Information based
Social comparison T1 ⫺.20ⴱ ⫺.16ⴱ television .06 ⫺.04 .02
⌬ Social comparison ⫺.23ⴱⴱ ⫺.16ⴱ Activities
ⴱⴱ
Body appreciation T1 .25 .17ⴱ Sports and physical
⌬ Body appreciation .36ⴱⴱ .26ⴱⴱ activities ⫺.07 .14ⴱⴱ ⫺.02
Final model adjusted R2 .395 .508 .507 .546 Hobbies ⫺.00 .01 ⫺.02
Note. ⌬ ⫽ change. Note. BA ⫽ body appreciation.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .001. ⴱ
p ⫽ .05. ⴱⴱ p ⬍ .05. ⴱⴱⴱ p ⬍ .001.
 PREDICTORS AND OUTCOMES OF GIRLS’ POSITIVE BODY IMAGE 469
2
temporally precede body appreciation, Rchange ⫽ .007, Fchange(1, Table 6
291) ⫽ 4.55, ␤ ⫽ .09, p ⫽ .03. The sign of the ␤ indicates that Hierarchical Regression Results Predicting Outcomes From
greater perceived body acceptance by others at Time 1 predicted Time 1 Body Appreciation
an increase in body appreciation from Time 1 to Time 2.
We also examined the potential for reverse causation, that is, Variable B SE B ␤ ⌬R2 ⌬F
whether initial levels of body appreciation predicted change in any Dieting behavior ⫺.25 .09 ⫺.15ⴱ .014 7.77ⴱ
of the postulated predictors. Here we found that body appreciation Fruit consumption .05 .11 .02 .001 .22
at Time 1 predicted increased perceived body acceptance by others Vegetable consumption .08 .14 .03 .001 .38
2
at Time 2, Rchange ⫽ .019, Fchange(1, 294) ⫽ 9.37, ␤ ⫽ .15, p ⫽ Takeaway consumption ⫺.08 .07 ⫺.06 .001 1.40
Sun protection .23 .16 .05 .003 2.02
.002, indicating that the relationship between perceived body ac- Alcohol consumption ⫺.30 .08 ⫺.18ⴱⴱ .032 13.77ⴱⴱ
ceptance by others and body appreciation was bidirectional. Body Cigarette smoking ⫺.05 .02 ⫺.13ⴱ .017 6.70ⴱ
appreciation at Time 1 also predicted an increase in sports and Weekly sleep .61 .42 .07 .005 2.13
2
physical activity participation at Time 2, Rchange ⫽ .015, Fchange(1, Medical attention .01 .07 .01 .000 .01
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295) ⫽ 6.45, ␤ ⫽ .12, p ⫽ .01. ⴱ

p ⬍ .05. ⴱⴱ
p ⬍ .001.
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Outcomes of Body Appreciation

takeaway consumption, sun protection, weekly sleep, or medical
A number of health-related outcomes were examined in relation
attention.
to body appreciation. Table 5 presents the correlations between
Because there was generally low reported use of alcohol and
body appreciation and health behaviors separately at Time 1 and
cigarette consumption at both time points, but these behaviors
Time 2 (within time), as well as the correlations between Time 1
increased significantly over time (see Table 1), they were exam-
body appreciation and Time 2 health behaviors. As can be seen, at
ined in more detail. To do this, participants were split into quartiles
both Time 1 and Time 2 girls with higher body appreciation
based on Time 1 body appreciation, and the uptake of alcohol and
reported significantly more sun protection behaviors, weekly
cigarettes was examined for the lowest (M ⫽ 2.33, SD ⫽ 0.47) and
sleep, seeking medical attention, and significantly less dieting,
the highest body appreciation quartiles (M ⫽ 4.43, SD ⫽ 0.24).
cigarette, and alcohol consumption. At Time 2, an additional
For alcohol consumption, 53.4% of girls with low body appreci-
negative relationship was found between body appreciation and
ation had consumed some alcohol at Time 1, with 71.9% reporting
takeaway consumption. Cross-lagged correlations showed that
use by Time 2, representing an increase of 18.5%. In contrast, for
body appreciation at Time 1 was positively related to Time 2 sun
girls with high body appreciation, only 25.6% had consumed
protection, weekly sleep and seeking medical attention, and neg-
alcohol at Time 1, increasing to 38.5% at Time 2, representing (a
atively related to Time 2 dieting behavior, alcohol consumption,
lesser) 12.9% increase. For cigarette consumption, 6.7% of girls
and cigarette smoking.
with low body appreciation had tried cigarettes at Time 1, increas-
Separate hierarchical multiple regressions were undertaken to
ing markedly to 21.3% at Time 2, an increase of 14.6%. For girls
examine whether Time 1 body appreciation temporally preceded
with high body appreciation, however, rates increased only a little,
change in health behaviors over a 1 year period. In each regression,
from 1.3% at Time 1 to 5.2% at Time 2, an increase of only 3.9%.
the Time 1 health behavior was entered in Step 1, with Time 1
It can be seen that those girls with high body appreciation were not
body appreciation entered in Step 2. The Time 2 health behavior
only less likely to consume alcohol or cigarettes initially, but were
was the outcome variable. Table 6 displays the results for Step 2
also less likely to take up the behaviors over a 1-year time period.
of the individual regressions. It can be seen that Time 1 body
To examine the reverse relationships, that is, whether any of the
appreciation significantly predicted decreased dieting behavior,
postulated health outcome variables predicted change in body
alcohol consumption, and cigarette smoking 1 year later. Time 1
appreciation over time, another series of hierarchical multiple
body appreciation did not predict change in fruit, vegetable or
regressions was conducted. It was found that lower levels of Time
2
1 dieting predicted increased body appreciation at Time 2, Rchange ⫽
Table 5 .009, Fchange(1, 291) ⫽ 5.51, ␤ ⫽ ⫺.12, p ⫽ .02, indicating that the
Correlations Within and Between Time for Body Appreciation relationship between body appreciation and dieting was bidirectional.
and Outcome Variables
Discussion
Cross-lagged: T1
Outcome variable Within T1 Within T2 BA, T2 outcome The current study sought to extend knowledge regarding pro-
Dieting behavior ⫺.59 ⴱⴱ
⫺.59 ⴱⴱ
⫺.50 ⴱⴱ spective predictors and outcomes of positive body image in ado-
Fruit consumption ⫺.02 .05 .04 lescent girls. To date, few studies have explored body appreciation
Vegetable consumption .03 .02 .08 in adolescents. Further, no longitudinal examinations of body
Takeaway consumption ⫺.05 ⫺.19ⴱ ⫺.09 appreciation have been previously reported for any age group. The
Sun protection .21ⴱⴱ .21ⴱⴱ .22ⴱⴱ
Alcohol consumption ⫺.23ⴱⴱ ⫺.22ⴱⴱ ⫺.30ⴱⴱ
key findings from our study are clear. First, a longitudinal test of
Cigarette smoking ⫺.11ⴱ ⫺.12ⴱ ⫺.19ⴱ the modified acceptance model of intuitive eating showed that
Weekly sleep .22ⴱⴱ .25ⴱⴱ .23ⴱⴱ perceived body acceptance by others (positively), self-objectification
Medical attention .19ⴱ .16ⴱ .12ⴱ and social comparison (negatively), and body appreciation (posi-
Note. BA ⫽ body appreciation. tively) predicted an increase in intuitive eating over 1 year in
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .001. adolescent girls. Second, perceived body acceptance by others also
 470 ANDREW, TIGGEMANN, AND CLARK

prospectively predicted an increase in body appreciation 1 year ies that have shown body appreciation to ameliorate negative
later. Finally, body appreciation itself predicted decreased dieting effects on body image resulting from exposure to thin-ideal media
behavior, and alcohol and cigarette consumption, and increased (Andrew et al., 2015a; Halliwell, 2013). Similar to media con-
physical activity, 1 year later. sumption, participation in sporting activities was correlated with
The first aim of the present study was to longitudinally examine body appreciation within time but not over time.
the modified acceptance model of intuitive eating in adolescent The final aim of the present study was to examine a range of
girls. Consistent with the postulated causal model, we found that potential health outcomes of body appreciation over 1 year. The
initially higher perceived body acceptance by others, lower self- only two other studies to have examined health outcomes of body
objectification and social comparison, and greater body apprecia- appreciation (Andrew et al., 2014; Gillen, 2015) were cross-
tion predicted higher intuitive eating over time. Our findings sectional in nature and sampled young adults. In our sample of
support previous correlational tests of the model in adult female adolescent girls, we found that body appreciation predicted de-
samples (Augustus-Horvath & Tylka, 2011; Avalos & Tylka, creased dieting over a 1 year period, and that this relationship was
2006; Oh et al., 2012). However, the longitudinal research design bidirectional. Our prospective findings extend previous correla-
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of the current study has enabled confirmation of the postulated tional results indicating a negative association between body ap-
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temporal sequence of variables in the model, consistent with their preciation and dieting behavior in adult women (Andrew et al.,
proposed causal role. Thus, the findings highlight factors impor- 2014; Gillen, 2015). Although we conceptualized participation in
tant in the development of a healthy and adaptive eating style in physical activity as a potential predictor of body appreciation, we
adolescent girls. found instead that greater initial body appreciation in our sample
To examine potential predictors of body appreciation, we mea- of girls was associated with increased participation in sports and
sured several variables that we reasoned might have a positive physical activity 1 year later. Future research might usefully ex-
impact on body image. However, of the postulated predictors amine more precisely the nature of the relationship between body
tested, only perceived body acceptance by others prospectively appreciation and engagement in physical activity in samples of
predicted an increase in body appreciation. Specifically, girls who different ages.
initially felt more weight and shape acceptance from their family More important, we found a significant prospective relationship
and peers expressed greater appreciation for their body 1 year later. between body appreciation and alcohol and cigarette consumption.
This confirms longitudinally the association that has been shown In particular, body appreciation was found to predict uptake over
in a number of cross-sectional studies (Augustus-Horvath & Tylka, time. Specifically, girls with high body appreciation were less
2011; Avalos & Tylka, 2006; Kroon Van Diest & Tylka, 2010; Oh likely to take up smoking cigarettes or drinking alcohol between
et al., 2012). It is likely that the girls in our study who perceived time points than their counterparts with low body appreciation.
that their body was accepted by those important to them, possibly This is a key finding of the current study because alcohol and other
through subtle nonjudgemental messages about appearance, may drug use can have a negative impact on adolescent development in
have been less likely to experience preoccupation with appearance both cognitive and social domains, and such use also increases the
and instead feel respect and appreciation for their body (Tylka & risk of accidental injury (Hawkins, Catalano, & Miller, 1992).
Wood-Barcalow, 2015a). In addition, prediction in the reverse Collectively, these results provide empirical support to the sug-
direction was also found, indicating that the relationship between gestion that individuals with body appreciation will engage in
perceived body acceptance by others and body appreciation was self-care behaviors that benefit physical health, and actively avoid
bidirectional. Thus, girls with greater body appreciation may have behaviors that could physically harm their body (Tylka, 2011,
intentionally surrounded themselves with peers who were body 2012).
positive and communicated body acceptance (Tylka, 2011, 2012).
This type of reciprocal relationship has been suggested as a core
Practical Implications
feature of positive body image, and one that should serve to
strengthen and maintain positive body image (Tylka, 2011, 2012; Our results suggest that body appreciation has important impli-
Wood-Barcalow et al., 2010). cations for adolescent girls. Indeed, body appreciation may have
Although neither of our proposed classes of predictors regarding benefits for girls across a wide range of domains. In particular, the
media or sports was found to prospectively predict body appreci- findings from the current study suggest that fostering body appre-
ation, Time 1 appearance media consumption (negatively) and ciation may be beneficial and protective for girls’ health, in terms
reading nonfashion magazines (positively) were related to Time 1 of decreased dieting, increased physical activity, and protection
body appreciation. Given the decreasing levels of appearance against alcohol and cigarette use. Given the high rates of dieting
media consumption found between Time 1 and Time 2, it may be among adolescent girls (e.g., Paxton et al., 1991), our finding in
that any effect of media consumption on body appreciation has relation to decreased dieting suggests that enhancing body appre-
already been established by early adolescence, perhaps as a result ciation might be one way to tackle the development of maladaptive
of media saturation and transmission of beauty ideals in Western eating behaviors. The observed reciprocal relationship between
society (Levine & Chapman, 2011). Furthermore, it may not be the body appreciation and dieting also suggests that encouraging girls
amount of media viewed by girls that is critical, but rather how it to take a balanced and nonrestrictive approach to food intake might
is viewed. For example, girls with higher body appreciation may help foster their body appreciation. Thus, interventions and public
process appearance media more critically, by analyzing its content health programs targeted at adolescents that focus on controlling
and consciously “filtering” messages in a way that is protective weight and diet may negatively impact on their body appreciation.
and strengthens body image (Tylka, 2011; Wood-Barcalow et al., More holistic programs such as Health at Every Size (Bacon,
2010). This is consistent with results from two experimental stud- Stern, Van Loan, & Keim, 2005) or BodiMojo (Franko, Cousineau,
 PREDICTORS AND OUTCOMES OF GIRLS’ POSITIVE BODY IMAGE 471

Rodgers, & Roehrig, 2013) that focus on a healthy lifestyle, body girls might be trained in mindfulness and acceptance techniques
acceptance, and challenging weight stigma are likely to be more that emphasize observation, but not judgment or modification of
beneficial for physical and psychological health (Tylka et al., thoughts, emotions, or physical sensations (Baer, 2003).
2014). Although we only found one major significant prospective pre-
Our results indicate that enhancing body appreciation may also dictor of body appreciation in the current study, there may be other
improve girls’ participation rates in sports and physical activity. potential ways in which positive body image can be fostered in
Australian figures show that participation in sporting activities adolescent girls. One possibility is to encourage engagement in
declines across adolescence at a considerably faster rate for girls more embodying activities (see Menzel & Levine, 2011). Apart
than boys (Australian Bureau of Statistics, 2013). This decrease from yoga, we did not measure other mindfulness-based activities
may have a broad impact on the well-being of adolescent girls, as like mindful meditation, which emphasize the mind-body connec-
physical activity has a wide range of demonstrated psychological tion and might be more likely to enhance body appreciation.
and physical health benefits (e.g., Warburton, Nicol, & Bredin, Increasing self-compassion may be another way to enhance body
2006). Thus, enhancing girls’ body appreciation may assist in appreciation. One study has shown self-compassion to protect
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

increasing their participation in physical activity throughout ado- body appreciation against body image-related threats such as ap-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

lescence. pearance comparison in women (Homan & Tylka, 2015). Self-

The findings from the current study suggest that body appreci- compassionate meditation has also been shown to increase body
ation may influence the uptake of alcohol consumption and ciga- appreciation in adult women (Albertson et al., 2015). Thus, future
rette smoking. Because of the known detrimental impacts on research might explore whether self-compassion, via self-compassion
physical health, current Australian national alcohol guidelines training, may be one way to increase body appreciation in adoles-
recommend that the safest option for adolescents is to delay cents. As suggested by Piran (2015), already established body
alcohol consumption for as long as possible (National Health and image intervention programs may also assist in increasing body
Medical Research Council, 2009), and the uptake of adolescent appreciation while simultaneously tackling negative body image.
cigarette smoking is specifically targeted in the National Tobacco For example, a recent study found that a 1-hr dissonance-based
Strategy (Commonwealth of Australia, 2012). Our findings indi- intervention in which adolescent girls took part in several activities
cate that middle adolescence may be an effective time point for that encouraged rejection of the thin ideal, not only decreased body
interventions to target alcohol and cigarette use. They also point to dissatisfaction but also increased body appreciation (Halliwell,
enhancing positive body image as one way in which to protect Jarman, McNamara, Risdon, & Jankowski, 2015). Therefore, fu-
adolescent girls from taking up, or at least delaying engagement in, ture body image interventions could usefully include positive body
these unhealthy behaviors. image measures to explore which aspects of established interven-
As previously suggested by Andrew and colleagues (2014), tion programs assist in enhancing positive body image (Halliwell,
developing strategies that aim to increase positive body image to 2015; Piran, 2015).
target beneficial outcomes may prove a less challenging task than
attempting to reduce body dissatisfaction. As positive body image
Limitations and Future Directions
has been shown to be distinct from negative body image (see
Andrew et al., 2014; Avalos et al., 2005; Tylka & Wood-Barcalow, As with all research, the current study contains limitations that
2015b), it may be possible to increase positive body image, even need to be acknowledged. First, although participating schools
despite some level of body dissatisfaction. This is particularly from which participants were sourced ranged in socioeconomic
salient for adolescent girls who are constantly confronted with status, the sample comprised mainly girls in middle adolescence
media messages emphasizing a narrow and often unattainable who were White. This limits our ability to generalize findings to
standard of beauty (Levine & Chapman, 2011), and a high pro- younger and older adolescents, and to girls of different ethnicities.
portion of whom are dissatisfied with their appearance (Wertheim Future studies should attempt to survey a more diverse range in
& Paxton, 2011). terms of age, ethnicity, and geographical location. Second, we
To better locate potential targets for increasing body apprecia- explored only a limited number of potential predictors of body
tion, we investigated a range of possible predictors, but had limited appreciation. Future studies might attempt to include a greater
success. Perceived body acceptance by others, but not media range of predictors and use validated measures of these variables,
consumption or engagement in sporting or other activities, pro- as our measures of media consumption and activities needed to be
spectively predicted body appreciation 1 year later. Perceived body specifically constructed for the current study. In addition, the most
acceptance by others may be targeted in two main ways. The first recent body appreciation (BAS-2; Tylka & Wood-Barcalow,
is to increase the acceptance of girls’ appearance by significant 2015b) and intuitive eating (IES-2; Tylka & Kroon Van Diest,
others. Thus, interventions might aim to increase parental or peer 2013) scales were not used as they were published after the
awareness of the importance of displaying an accepting and non- commencement of the study. Finally, a 1-year time period between
judgemental stance toward their daughters’ or friends’ appearance measurement points may not have been sufficient to detect some
and body shape. The second is to target adolescent girls them- changes. Nor may the measures have been administered at the
selves. Unhelpful thinking styles described in cognitive behavior critical developmental stage for some aspects assessed. However,
therapy such as catastrophizing and black and white thinking we were able to observe significant change and prospective pre-
(Beck, 1979, 2011) may contribute to an inaccurate and negatively diction of intuitive eating, dieting, physical activity, alcohol, and
biased perception of body-related messages. Thus, cognitive– cigarette use. Future research should endeavor to track adolescents
behavioral interventions could incorporate training for girls on over a longer time period, ideally from early adolescence to young
unhelpful thinking styles and thought challenging. Alternatively, adulthood, to capture change more comprehensively. Assessing
 472 ANDREW, TIGGEMANN, AND CLARK

body appreciation over several more time points would also be Bacon, L., Stern, J. S., Van Loan, M. D., & Keim, N. L. (2005). Size
useful in ruling out third variable explanations. More generally, acceptance and intuitive eating improve health for obese, female chronic
longitudinal examination of predictors and outcomes of body dieters. Journal of the American Dietetic Association, 105, 929 –936.
appreciation should also be extended to adult female samples. http://dx.doi.org/10.1016/j.jada.2005.03.011
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A
conceptual and empirical review. Clinical Psychology: Science and
Conclusions Practice, 10, 125–143. http://dx.doi.org/10.1093/clipsy.bpg015
Bailey, K. A., Gammage, K. L., van Ingen, C., & Ditor, D. S. (2015). “It’s
Despite the above limitations, the current study has contributed all about acceptance”: A qualitative study exploring a model of positive
to our understanding of positive body image in adolescent girls. As body image for people with spinal cord injury. Body Image, 15, 24 –34.
one of few studies to examine body appreciation in an adolescent http://dx.doi.org/10.1016/j.bodyim.2015.04.010
population and the first to do so longitudinally, the findings show Beck, A. T. (1979). Cognitive therapy and the emotional disorders. Ox-
that it is possible to detect prospective predictors and outcomes of ford, England: International Universities Press.
positive body image in adolescent girls over a relatively short time Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

period of 1 year. The results provide longitudinal support for the York, NY: Guilford Press.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Commonwealth of Australia. (2008). Go for 2 & 5. Retrieved from http://

modified acceptance model of intuitive eating and highlight per-
www.healthyactive.gov.au/internet/healthyactive/Publishing.nsf/Content/
ceived body acceptance by others as a predictor of body appreci-
2and5
ation, and body appreciation as a prospective predictor of de- Commonwealth of Australia. (2012). National tobacco strategy 2012–
creased dieting, increased physical activity, and decreased alcohol 2018. Canberra: Department of Health and Ageing.
and cigarette use, over time. Taken together, the results suggest Dobbinson, S., Wakefield, M., Hill, D., Girgis, A., Aitken, J. F., Beck-
that body appreciation is indeed a very salient concept in this age mann, K., . . . Bowles, K. A. (2008). Prevalence and determinants of
group, one associated with a wide range of potential benefits. Australian adolescents’ and adults’ weekend sun protection and sunburn,
summer 2003–2004. Journal of the American Academy of Dermatology,
59, 602– 614. http://dx.doi.org/10.1016/j.jaad.2008.06.011
References Dockendorff, S. A., Petrie, T. A., Greenleaf, C. A., & Martin, S. (2012).
Intuitive eating scale: An examination among early adolescents. Journal
Aarts, H., Paulussen, T., & Schaalma, H. (1997). Physical exercise habit:
of Counseling Psychology, 59, 604 – 611. http://dx.doi.org/10.1037/
On the conceptualization and formation of habitual health behaviours.
a0029962
Health Education Research, 12, 363–374. http://dx.doi.org/10.1093/her/
Eccles, J. S. (1999). The development of children ages 6 to 14. The Future
12.3.363
of Children, 9, 30 – 44. http://dx.doi.org/10.2307/1602703
Albertson, E. R., Neff, K. D., & Dill-Shackleford, K. E. (2015). Self-
Franko, D. L., Cousineau, T. M., Rodgers, R. F., & Roehrig, J. P. (2013).
compassion and body dissatisfaction in women: A randomized con-
BodiMojo: Effective Internet-based promotion of positive body image in
trolled trial of a brief meditation intervention. Mindfulness, 6, 444 – 454.
adolescent girls. Body Image, 10, 481– 488. http://dx.doi.org/10.1016/j
http://dx.doi.org/10.1007/s12671-014-0277-3
Allison, P. D. (1990). Change scores as dependent variables in regression .bodyim.2013.04.008
analysis. Sociological Methodology, 20, 93–114. http://dx.doi.org/10 Fredrickson, B. L., & Roberts, T.-A. (1997). Objectification theory: To-
.2307/271083 ward understanding women’s lived experiences and mental health risks.
Andrew, R., Tiggemann, M., & Clark, L. (2014). Positive body image and Psychology of Women Quarterly, 21, 173–206. http://dx.doi.org/10
young women’s health: Implications for sun protection, cancer screen- .1111/j.1471-6402.1997.tb00108.x
ing, weight loss and alcohol consumption behaviours. Journal of Health Frisén, A., & Holmqvist, K. (2010). What characterizes early adolescents
Psychology, 1–12. [Advance online publication.] http://dx.doi.org/10 with a positive body image? A qualitative investigation of Swedish girls
.1177/1359105314520814 and boys. Body Image, 7, 205–212. http://dx.doi.org/10.1016/j.bodyim
Andrew, R., Tiggemann, M., & Clark, L. (2015a). The protective role of .2010.04.001
body appreciation against media-induced body dissatisfaction. Body Gillen, M. M. (2015). Associations between positive body image and
Image, 15, 98 –104. http://dx.doi.org/10.1016/j.bodyim.2015.07.005 indicators of men’s and women’s mental and physical health. Body
Andrew, R., Tiggemann, M., & Clark, L. (2015b). Predictors of intuitive Image, 13, 67–74. http://dx.doi.org/10.1016/j.bodyim.2015.01.002
eating in adolescent girls. Journal of Adolescent Health, 56, 209 –214. Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The role of the media in body
http://dx.doi.org/10.1016/j.jadohealth.2014.09.005 image concerns among women: A meta-analysis of experimental and
Augustus-Horvath, C. L., & Tylka, T. L. (2011). The acceptance model of correlational studies. Psychological Bulletin, 134, 460 – 476. http://dx
intuitive eating: A comparison of women in emerging adulthood, early .doi.org/10.1037/0033-2909.134.3.460
adulthood, and middle adulthood. Journal of Counseling Psychology, Graber, J. A., Brooks-Gunn, J., Paikoff, R. L., & Warren, M. P. (1994).
58, 110 –125. http://dx.doi.org/10.1037/a0022129 Prediction of eating problems: An 8-year study of adolescent girls.
Australian Bureau of Statistics. (2011). Census of population and housing: Developmental Psychology, 30, 823– 834. http://dx.doi.org/10.1037/
Socio-Economic Indexes for Areas (SEIFA), Australia (2033.0.55.001). 0012-1649.30.6.823
Retrieved from http://www.abs.gov.au/ausstats/[email protected]/DetailsPage/ Halliwell, E. (2013). The impact of thin idealized media images on body
2033.0.55.0012011?OpenDocument satisfaction: Does body appreciation protect women from negative ef-
Australian Bureau of Statistics. (2013). Australian health survey: Physical fects? Body Image, 10, 509 –514. http://dx.doi.org/10.1016/j.bodyim
activity, 2011–12. Cat. no. 4364.0.55.004. Canberra: ABS. .2013.07.004
Avalos, L. C., & Tylka, T. L. (2006). Exploring a model of intuitive eating Halliwell, E. (2015). Future directions for positive body image research.
with college women. Journal of Counseling Psychology, 53, 486 – 497. Body Image, 14, 177–189. http://dx.doi.org/10.1016/j.bodyim.2015.03
http://dx.doi.org/10.1037/0022-0167.53.4.486 .003
Avalos, L., Tylka, T. L., & Wood-Barcalow, N. (2005). The Body Appre- Halliwell, E., Jarman, H., McNamara, A., Risdon, H., & Jankowski, G.
ciation Scale: Development and psychometric evaluation. Body Image, (2015). Dissemination of evidence-based body image interventions: A
2, 285–297. http://dx.doi.org/10.1016/j.bodyim.2005.06.002 pilot study into the effectiveness of using undergraduate students as
 PREDICTORS AND OUTCOMES OF GIRLS’ POSITIVE BODY IMAGE 473

interventionists in secondary schools. Body Image, 14, 1– 4. http://dx.doi weight loss behaviors in adolescent girls and boys. Journal of Youth and
.org/10.1016/j.bodyim.2015.02.002 Adolescence, 20, 361–379. http://dx.doi.org/10.1007/BF01537402
Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective Piran, N. (2001). Re-inhabiting the body from the inside out: Girls trans-
factors for alcohol and other drug problems in adolescence and early form their school environment. In D. L. Tolman & M. Brydon-Miller
adulthood: Implications for substance abuse prevention. Psychological (Eds.), From subjects to subjectivities: A handbook of interpretative and
Bulletin, 112, 64 –105. http://dx.doi.org/10.1037/0033-2909.112.1.64 participatory methods (pp. 218 –238). New York, NY: New York Uni-
Holmqvist, K., & Frisén, A. (2012). “I bet they aren’t that perfect in versity Press.
reality:” Appearance ideals viewed from the perspective of adolescents Piran, N. (2002). Embodiment: A mosaic of inquiries in the area of body
with a positive body image. Body Image, 9, 388 –395. http://dx.doi.org/ weight and shape preoccupation. In S. M. Abbey (Ed.), Ways of knowing
10.1016/j.bodyim.2012.03.007 in and through the body: Diverse perspectives on embodiment (pp.
Homan, K. J., & Tylka, T. L. (2015). Self-compassion moderates body 211–214). Welland, Canada: Soliel.
comparison and appearance self-worth’s inverse relationships with body Piran, N. (2015). New possibilities in the prevention of eating disorders:
appreciation. Body Image, 15, 1–7. http://dx.doi.org/10.1016/j.bodyim The introduction of positive body image measures. Body Image, 14,
.2015.04.007 146 –157. http://dx.doi.org/10.1016/j.bodyim.2015.03.008
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Jáuregui Lobera, I., & Bolaños Ríos, P. (2011). Spanish version of the Pruzinsky, T., & Cash, T. F. (2002). Understanding body images: Histor-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Body Appreciation Scale (BAS) for adolescents. The Spanish Journal of ical and contemporary perspectives. In T. F. Cash & T. Pruzinsky (Eds.),
Psychology, 14, 411– 420. http://dx.doi.org/10.5209/rev_SJOP.2011.v14 Body image: A handbook of theory, research, and clinical practice (pp.
.n1.37 3–12). New York, NY: Guilford Press.
Kroon Van Diest, A. M., & Tylka, T. L. (2010). The Caregiver Eating Schutz, H. K., Paxton, S. J., & Wertheim, E. H. (2002). Investigation of
Messages Scale: Development and psychometric investigation. Body body comparison among adolescent girls. Journal of Applied Social
Image, 7, 317–326. http://dx.doi.org/10.1016/j.bodyim.2010.06.002 Psychology, 32, 1906 –1937. http://dx.doi.org/10.1111/j.1559-1816
Levine, M. P., & Chapman, K. (2011). Media influences on body image. In .2002.tb00264.x
T. F. Cash & L. Smolak (Eds.), Body image: A handbook of science, Slater, A., & Tiggemann, M. (2002). A test of objectification theory in
practice, and prevention (pp. 101–109). New York, NY: Guilford Press. adolescent girls. Sex Roles, 46, 343–349. http://dx.doi.org/10.1023/A:
Lobera, I. J., Ríos, P. B., Fernández, M. J. S., & Casals Elsa Sánchez, O. G. 1020232714705
(2011). Perception of weight and psychological variables in a sample of Stice, E. (2002). Risk and maintenance factors for eating pathology: A
Spanish adolescents. Diabetes. Metabolic Syndrome and Obesity: Tar- meta-analytic review. Psychological Bulletin, 128, 825– 848. http://dx
gets and Therapy, 4, 245–251. .doi.org/10.1037/0033-2909.128.5.825
Lunde, C. (2013). Acceptance of cosmetic surgery, body appreciation, Thompson, J. K., Heinberg, L. J., Altabe, M. N., & Tantleff-Dunn, S.
body ideal internalization, and fashion blog reading among late adoles- (1999). Exacting beauty: Theory, assessment and treatment of body
cents in Sweden. Body Image, 10, 632– 635. http://dx.doi.org/10.1016/j image disturbance. Washington, DC: American Psychological Associa-
.bodyim.2013.06.007 tion. http://dx.doi.org/10.1037/10312-000
McHugh, T. L. F., Coppola, A. M., & Sabiston, C. M. (2014). “I’m Thompson, J. K., Heinberg, L. J., & Tantleff-Dunn, S. (1991). The Physical
thankful for being Native and my body is part of that”: The body pride Appearance Comparison Scale (PACS). Behavior Therapist, 14, 174.
experiences of young Aboriginal women in Canada. Body Image, 11, Tiggemann, M., & Miller, J. (2010). The internet and adolescent girls’
318 –327. http://dx.doi.org/10.1016/j.bodyim.2014.05.004 weight satisfaction and drive for thinness. Sex Roles, 63, 79 –90. http://
McKinley, N. M., & Hyde, J. S. (1996). The Objectified Body Conscious- dx.doi.org/10.1007/s11199-010-9789-z
ness Scale: Development and validation. Psychology of Women Quar- Tribole, E., & Resch, E. (1995). Intuitive eating: A recovery book for the
terly, 20, 181–215. http://dx.doi.org/10.1111/j.1471-6402.1996 chronic dieter. New York, NY: St. Martin’s Press.
.tb00467.x Tylka, T. L. (2006). Development and psychometric evaluation of a mea-
Menard, S. (1991). Longitudinal research. Newbury Park, CA: Sage. sure of intuitive eating. Journal of Counseling Psychology, 53, 226 –240.
Menzel, J. E., & Levine, M. P. (2011). Embodying experiences and the http://dx.doi.org/10.1037/0022-0167.53.2.226
promotion of positive body image: The example of competitive athletics. Tylka, T. L. (2011). Positive psychology perspectives on body image. In
In R. M. Calogero, S. Tantleff-Dunn, & J. K. Thompson (Eds.), Self- T. F. Cash & L. Smolak (Eds.), Body image: A handbook of science,
objectification in women: Causes, consequences, and counteractions practice, and prevention (2nd ed., pp. 56 – 64). New York, NY: Guilford
(pp. 163–186). Washington, DC: American Psychological Association. Press.
http://dx.doi.org/10.1037/12304-008 Tylka, T. L. (2012). Positive psychology perspectives on body image. In
National Health and Medical Research Council. (2009). Australian guide- T. F. Cash (Ed.), Encyclopedia of body image and human appearance
lines to reduce health risks from drinking alcohol. Canberra: Common- (Vol. 2, pp. 657– 663). Oxford, England: Academic Press. http://dx.doi
wealth of Australia. .org/10.1016/B978-0-12-384925-0.00104-8
National Health and Medical Research Council. (2013). Australian dietary Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E.,
guidelines. Canberra: Commonwealth of Australia. Davis, C., & Calogero, R. M. (2014). The weight-inclusive versus
O’Brien, K. S., Caputi, P., Minto, R., Peoples, G., Hooper, C., Kell, S., & weight-normative approach to health: Evaluating the evidence for pri-
Sawley, E. (2009). Upward and downward physical appearance com- oritizing well-being over weight loss. [Advance online publication].
parisons: Development of scales and examination of predictive qualities. Journal of Obesity, 2014, 983495.
Body Image, 6, 201–206. http://dx.doi.org/10.1016/j.bodyim.2009.03 Tylka, T. L., & Kroon Van Diest, A. M. (2013). The Intuitive Eating
.003 Scale-2: Item refinement and psychometric evaluation with college
Oh, K. H., Wiseman, M. C., Hendrickson, J., Phillips, J. C., & Hayden, women and men. Journal of Counseling Psychology, 60, 137–153.
E. W. (2012). Testing the acceptance model of intuitive eating with http://dx.doi.org/10.1037/a0030893
college women athletes. Psychology of Women Quarterly, 36, 88 –98. Tylka, T. L., & Wood-Barcalow, N. L. (2015a). What is and what is not
http://dx.doi.org/10.1177/0361684311433282 positive body image? Conceptual foundations and construct definition.
Paxton, S. J., Wertheim, E. H., Gibbons, K., Szmukler, G. I., Hillier, L., & Body Image, 14, 118 –129. http://dx.doi.org/10.1016/j.bodyim.2015.04
Petrovich, J. L. (1991). Body image satisfaction, dieting beliefs, and .001
 474 ANDREW, TIGGEMANN, AND CLARK

Tylka, T. L., & Wood-Barcalow, N. L. (2015b). The Body Appreciation adolescent girls. In T. F. Cash & L. Smolak (Eds.), Body image: A
Scale-2: Item refinement and psychometric evaluation. Body Image, 12, handbook of science, practice, and prevention (2nd ed., pp. 76 – 84).
53– 67. http://dx.doi.org/10.1016/j.bodyim.2014.09.006 New York, NY: Guilford Press.
Warburton, D. E., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefits Wood-Barcalow, N. L., Tylka, T. L., & Augustus-Horvath, C. L. (2010).
of physical activity: The evidence. Canadian Medical Association Jour- “But I Like My Body”: Positive body image characteristics and a holistic
nal, 174, 801– 809. http://dx.doi.org/10.1503/cmaj.051351 model for young-adult women. Body Image, 7, 106 –116. http://dx.doi
Wasylkiw, L., MacKinnon, A. L., & MacLellan, A. M. (2012). Exploring .org/10.1016/j.bodyim.2010.01.001
the link between self-compassion and body image in university women.
Body Image, 9, 236 –245. http://dx.doi.org/10.1016/j.bodyim.2012.01 Received June 12, 2015
.007 Revision received November 16, 2015
Wertheim, E. H., & Paxton, S. J. (2011). Body image development in Accepted November 19, 2015 䡲
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