Family Health|Kids and Teens
children|depression|mental health|teens

Body Image (Children and Teens)

Last Updated June 2023 | This article was created by editorial staff and reviewed by Daron Gersch, MD, FAAFP

Children’s opinions of their bodies form at a very young age. Research suggests that children as young as 3 years old can have body image issues. There are many things that influence how children see themselves. Parents can play a critical role in helping children develop a positive body image and self-esteem (how you see yourself and feel about yourself).

It’s difficult to escape the “ideal” body image that is promoted in today’s media (on TV, in magazines, on the internet, and in social media). No matter how much you try to shield your children from it, the message is likely to come through. This can happen at school as they interact with friends or as they observe the adults in their lives.

Even body language is not lost on children. Something as small as frowning in the mirror when you are trying on clothes can have an impact. This reinforces the message that a body needs to be perfect. That belief is the foundation for these building-block beliefs:

  • My body has to be perfect.
  • I’m not satisfied with my body.
  • A perfect body would make me happy.
  • A perfect body would earn me acceptance from others.
  • A perfect body would earn love and admiration, even attention.
  • Perfection is defined by a number on the scale or a size on a tag.
  • I will do anything to have a perfect body.

The problem is, a “perfect” body doesn’t really exist, at least not in the way it is defined in the media. Photos are often edited to make models thinner or to enhance their features. So, chasing the “perfect” body can end only in disappointment. This leads to poor self-esteem, which can impact all other aspects of life.

Poor body image is most often associated with girls, but boys suffer from it, too. They can feel as though they don’t have enough muscles or six-pack abs, or that they aren’t tall enough. One research study found that underweight boys are more likely to suffer from depression than are overweight girls.

Girls are, however, the most likely to suffer a negative outcome that involves eating disorders. Some of the most common eating disorders are anorexia (severely limiting food), bulimia (eating a large quantity of food, known as “binging,” and then throwing up the food, called “purging,” or by exercising or fasting to make up for overeating), and binge eating disorder (binging but not purging).

Path to improved health

Don’t wait until your child is older to begin guiding his or her opinions on body image. Studies show that children form opinions on what a body should look like at a much earlier age than we previously thought. In fact, it has been reported that children as young as 3 years old worry about being “fat.”

Now is the time to change the conversation. The way you talk about your body will influence your child. The meals you serve, the meals you eat, whether you exercise, and the importance you place on how you look will influence your child.

  • Don’t talk about dieting. Do talk about eating healthy, not dieting.
  • Don’t talk about exercising to lose weight. Do talk about exercising to be stronger.
  • Don’t talk about wanting to improve your body to be more attractive. Do talk about improving your body to be ready for whatever life has to offer.
  • Don’t shy away from being photographed. Do take every opportunity to document your life with your child. You’ll be glad that you’re “present” in their history.
  • Don’t use the “clean plate” measure of food. Do teach your child to pause and determine whether they are full or satisfied.
  • Don’t focus only on outer appearance. Do talk about what it means to be a good person. Praise your child on their “inner” attributes.
  • Don’t skip meals. Do show your children that it’s important to eat three healthy meals a day.
  • Don’t make every food decision for your child. Do give your child a say in what they eat. Let your child help choose foods at the grocery store. Use this time to educate your child on good food choices. Tell them that eating a variety of food is important for growing and to be strong. Teach them about vitamins and minerals.
  • Don’t eat only diet foods or fat-free foods. Do eat a variety of fruits, vegetables, and lean meats.

If you hear your child making comments about their body, don’t dismiss them. Talk about the comment and ask questions. For example, if your 8-year-old daughter says that her stomach is too big, don’t brush it off by saying, “Don’t be silly.” Ask her why she thinks it is too big. This will start a conversation and give you an opportunity to talk about what makes her special. You can steer the conversation back to having a healthy body and how our healthy bodies sometimes look different than what we see on TV and in magazines.

Also, your instinct may be to shield your child from TV. Instead, watch TV with your child and discuss what you see. Talk about how people are being portrayed. This gives you a chance to focus on character traits that are more important than outward appearances. You can remind your child of a time when they showed the same good character trait.

Things to consider

Body image is a big part of your child’s self-esteem. If children don’t like the way they look or are dissatisfied with their bodies, their self-esteem will suffer.

How they see themselves can affect every aspect of their lives — either negatively or positively. It affects their short- and long-term choices. It can impact their ability to meet people and make friends. It can prevent them from wanting to try new things or even seek higher education. These social consequences often last a lifetime.

There are health consequences, too. People with low self-esteem are more likely to be depressed and have anxiety. Experiencing and being treated for depression can cause weight gain, which makes low self-esteem even worse. Another common inappropriate way to cope is to develop an eating disorder. Each of these can have a negative impact on your child’s health.

When to see a doctor

To some extent, being preoccupied with body image is normal, especially during the tween and teen years. Do not worry too much about it, especially if you don’t see body image interfering with your child’s normal activity, friendships, or willingness to attend social gatherings. Continue to encourage your child and build his or her self-esteem during this time.

If you begin to see your child withdraw from their friends or from activities, it could be a warning sign of a more serious response to low self-esteem and body image.

Symptoms of depression

  • Social withdrawal (from friends/activities)
  • Low energy or lack of energy
  • Not able to control emotions (crying/yelling)
  • Irritability (gets mad easily)
  • Changes in sleep (sleeping more than usual or less than usual)
  • Changes in diet (not eating or eating more than usual)
  • Not talking as much as usual at home
  • Wanting to spend time alone

Symptoms of eating disorders

  • Excessive weight loss
  • Eating very small portions or skipping meals entirely
  • Exercising excessively
  • Eating large amounts of food without gaining weight
  • Finding excuses to go to the bathroom right after eating
  • Using diuretic pills and laxatives
  • Being secretive about eating
  • Sneaking large quantities of food to eat alone

Questions to ask your doctor

  • How can I talk to my child about their weight?
  • How can I recognize an eating disorder?
  • What can I do to help my child feel more confident?
  • How can I help my child develop healthy eating habits?
  • How can I lose weight without it negatively impacting my child’s sense of body image?
  • How do I explain to my child my decision to have cosmetic surgery?
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