Exploring body image as a means of preventing mental illness among south Asian young women and girls

Body dissatisfaction, defined as a 'negative evaluation of one's own
body' (1), is a major public health concern, with serious mental health
implications . Negative feelings about one's own body have been said
to be "a critical component" of the majority of eating disorders (ED),
where symptoms can include: having a distorted body image;
excessive dieting and severe weight loss; a consequent pathological
fear of regaining weight; as well as frequent episodes of "out of
control" binge eating sometimes followed by inappropriate purging
such as self-induced vomiting or laxative use (2). It is claimed that
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anorexia nervosa (AN) has the highest mortality rate of any other
psychiatric disorder (3).
Body Dysmorphic disorder (BDD), another psychiatric disorder which
is underpinned by an individual's body dissatisfaction, is defined as a
preoccupation with an 'imagined' or 'perceived' flaw or defect in
appearance, where the preoccupation causes clinically significant
distress or impairment in social, occupational, or other important
areas of functioning (4). The impact of this disorder is equally as
devastating as those with an ED, with it being reported that suicidality
is 45 times higher than that of the general population (5).
Other health implications of body dissatisfaction include an increased
risk of depression and anxiety, which in turn increases the risk of
engaging in more risk-taking behaviours such as self-harm,
substance misuse and other risk-taking activities (6).
To address this issue, Stice and colleagues have developed an
evidence-base for dissonance-based interventions (DBI) for the
alleviation of body dissatisfaction (7). The Body Project has evolved
over the last 16 years, and has produced a small number of
adaptations of the initial intervention scripts, resources and lessons
plans. One of the features of the project has been the use of 'peer
leaders' to deliver the intervention, as well as an adaptation of the
traditional Body Project to be suitable for orthodox Jewish adolescent
girls.
Following a systematic review conducted for my MSc studies (8) and
a subsequent feasibility study, I concluded that the needs of ethnic
minorities have not been extensively researched when it came to
delivering body image interventions, such that resources targeting
specific issues these groups may face are lacking.
Feasibility Study
In January-March 2018, I conducted a small scale feasibility study with
the charity Rethink Mental Illness. A generic school-based wellbeing
intervention responded to the demand for a body image and eating
disorder specific intervention that was suitable for Black, Asian and
Minority Ethnic (BAME) girls. Following a focus group (n=10),
emerging themes such as the impact of institutional racism, familial
attitudes towards eating and the impact of fasting religious practices
were raised as issues which weren't addressed in typical body image
interventions. This led to us co-designing content based on the
principles of evidence-based content such as appearance ideals, but
through a cultural lens.
As a result, culturally inclusive workshops addressing body image and
eating behaviours were co-produced and piloted in two London-based
schools. Results showed that post-intervention, 90% of participants
(n=40) felt able to use techniques to manage their body image
better and stated that they knew where to seek help should they
need to. The study also showed that using a co-production model
reaps mutual benefits for both the participants and the experts-byexperience involved in the co-design and co-delivery process.
Although this feasibility study is not yet published, it demonstrates a
foundation to this project proposal and provides rationale to the
proposed study.