Why Negative Body Image in Teens Matters More Than We Realize

Credit: Adobe Stock/Viacheslav Yakobchuk

A large twin study published in The Lancet Psychiatry showed that negative body image at 16 years of age is linked to eating disorder symptoms and depression in adulthood.

Many teenagers feel unhappy with their bodies, but researchers have long questioned whether body dissatisfaction actually causes later mental health challenges or whether the two are simply related.

This long-term study followed young people from adolescence into adulthood to better understand how body dissatisfaction at age 16 may influence eating disorder symptoms, depression and weight over time.

“In the last 20 years there has been a concerning increase in depression and eating disorders among young people, so it’s important to find out what is driving this increase in order to develop ways to prevent mental health problems from occurring,” said lead investigator Ilaria Costantini, Ph.D., from University College London (UCL)’s Division of Psychiatry.

What the Team Studied

The study used data from the Twins Early Development Study (TEDS), which followed twins born in England and Wales between 1994 and 1996 from childhood into adulthood. Because twins share genes and early environments, this design allowed investigators to explore whether body dissatisfaction independently contributed to later outcomes, as they were able to carefully separate the effects of genetics from environmental and emotional factors.

The team assessed body dissatisfaction at age 16, including feeling “fat,” concerns about weight gain, and judging themselves by their weight or body shape (using the Eating Disorder Diagnostic Scale). They also focused on eating disorder symptoms at age 21, depressive symptoms and body mass index (BMI) at ages 21 and 26.

In total, 2183 twins were included, most of which (93.5%) were White.

Key Findings at a Glance

Teens who reported higher body dissatisfaction at age 16 were more likely to experience the following:

• More eating disorder symptoms in young adulthood
• Higher levels of depressive symptoms
• Slightly higher BMI later on

These associations remained even after accounting for shared genetics and family background. The strongest link was between body dissatisfaction and eating disorder symptoms. Genetics played a major role, but nonshared environmental factors (such as personal experiences, stress or social pressures) also contributed.

The link between these associations was more pronounced among girls, although strong evidence for differences in sex was only seen in eating disorder symptoms, not depressive symptoms or BMI.

“In Western societies, we typically presume that young women are under greater pressure than young men to look a certain way, especially in relation to thinness, and our findings do suggest that these pressures may translate into stronger long-term mental health effects for girls,” explained Costantini.

“However, it is important to recognize that this may partly reflect the limited way in which body dissatisfaction was measured in this cohort. The items focused mainly on weight and shape, which tend to be more salient concerns for girls. If we had captured body dissatisfaction in a broader way — for example, by including muscularity, height, skin or other appearance-related concerns — our findings for boys might have been different.”

While this study used strong methods, investigators noted a few limitations to keep in mind. The number of participants, especially identical twins, may not have been large enough to detect smaller effects, and some teens who reported body dissatisfaction may have already had early or undiagnosed eating disorder symptoms. Because the study relied on self-reported data and focused mostly on weight- and shape-related concerns, it may not fully reflect body image issues that affect boys or people from different cultural backgrounds. Finally, since the study involved mostly White twins and did not include people with lived experience in its design, the findings may not apply to everyone.

What This Means for Mental Health

The findings suggest that body dissatisfaction in adolescence may do more than reflect existing emotional distress — it may actively contribute to the development of eating disorders and depression later in life.

Importantly, investigators point out the study supports the idea that early prevention matters. Helping teens develop healthier, more compassionate relationships with their bodies could reduce the risk of serious mental health challenges down the road.

Senior investigator Francesca Solmi, Ph.D., a professor within the Division of Psychiatry at UCL, emphasized: “It is vital that body dissatisfaction is tackled head-on during the teenage years across multiple settings, including in the school system, government health care strategies and in the wider culture.”