Body Image 6 (2009) 75–82

Contents lists available at ScienceDirect

Body Image
journal homepage: www.elsevier.com/locate/bodyimage

Is BodyThink an efficacious body image and self-esteem program?

A controlled evaluation with adolescents
Shanel M. Richardson a, Susan J. Paxton a,*, Julie S. Thomson b
a
School of Psychological Science, La Trobe University Bundoora, Victoria 3086, Australia
b
The Butterfly Foundation, Melbourne, Victoria, Australia

A R T I C L E I N F O A B S T R A C T

Article history: This study aimed to evaluate the efficacy of BodyThink, a widely disseminated body image and self-
Received 11 July 2008 esteem program. Participants were 277, grade 7 students from 4 secondary schools in Australia. The
Received in revised form 6 November 2008 intervention group (62 girls, 85 boys) participated in BodyThink during four 50-min lessons, while the
Accepted 10 November 2008
control group (65 girls, 65 boys) received their usual classes. All participants completed baseline,
postintervention and 3-month follow-up questionnaires. For girls, the intervention group reported
Keywords: higher media literacy and lower internalization of the thin ideal compared to the control group. For boys,
Body image
the intervention group reported higher media literacy and body satisfaction than the control group.
Body dissatisfaction
Although some positive outcomes were observed, it would be valuable to find ways to enhance the
Self-esteem
Prevention intervention impact of BodyThink, especially in light of its wide dissemination. Suggestions for improving BodyThink
Adolescent girls and boys are presented.
ß 2008 Elsevier Ltd. All rights reserved.

Introduction in the delivery of BodyThink to over 900 professionals and as of June

The importance of addressing the prevention of body dis-
satisfaction as a public health issue is increasingly being
recognised (Paxton, 2000). Body dissatisfaction has been found
to affect up to 70 percent of adolescent girls (Levine & Smolak,
2002) and 23 percent of adolescent boys (Bearman, Presnell,
Martinez, & Stice, 2006). In a recent survey of over 28,000
Australians aged 11–24 years, body image was identified as their
greatest issue of concern (Mission Australia, 2007). Further, body
dissatisfaction has been shown to predict the development of
depressed mood (Paxton, Neumark-Sztainer, Hannan, & Eisenberg,
2006b) and to be a risk and maintenance factor for the
development of eating disorders (Stice, 2002). This study aimed
to evaluate BodyThink, a body image and self-esteem program for
young people. It is especially important to evaluate this specific
program as it is being very widely disseminated.
BodyThink was developed by the United Kingdom Eating
Disorders Association, with input from the Dove Self-Esteem
Fund, The Butterfly Foundation, psychotherapists and the Girls
Scouts of the USA (Eating Disorders Association & Lever Faberge
Limited, 2006). The program has been disseminated throughout
schools in the United Kingdom (where it is called BodyTalk) (Dove,
2006). In Australia, The Butterfly Foundation has provided training
* Corresponding author. Tel.: +61 3 94791736; fax: +61 3 9479 1956.
E-mail address: susan.paxton@latrobe.edu.au (S.J. Paxton).
2008, 40,000 young people had participated in the program.
A large proportion of the content of BodyThink relates to media
literacy and self-esteem. Media literacy is the provision of
education on the media’s promotion of unrealistic standards of
‘beauty’ so that people learn to critically analyse media messages
(Wilksch, Tiggemann, & Wade, 2006). It can be argued that those
who have the skills to analyse media messages are less likely to be
adversely affected by such messages and therefore less susceptible
to body dissatisfaction. In regard to self-esteem, it has been
proposed that low self-esteem is a causal risk factor for body
dissatisfaction and therefore improving self-esteem will contri-
bute to a reduction in body dissatisfaction (Furnham, Badmin, &
Sneade, 2002). Research evidence supports self-esteem as a risk
factor for body dissatisfaction in adolescent girls (Paxton,
Einsenberg, & Neumark-Sztainer, 2006a).
In conjunction with media literacy and self-esteem, BodyThink
also aims to address additional likely causal risk factors for the
development of body dissatisfaction, including internalization of
the media ideal, body comparison and appearance teasing.
Internalization of the media ideal occurs when an individual
accepts the ideal promoted by the media (i.e., a thin ideal for
females and a muscular ideal for males) and evaluates his or her
body in relation to this ideal (Thompson, van den Berg, Roehrig,
Guarda, & Heinberg, 2004). It is argued that body dissatisfaction
results when an individual does not live up to the ideal (Stice,
2001) and research evidence supports this for girls and boys (Jones,
Vigfusdottir, & Lee, 2004; Smolak, Levine, & Thompson, 2001).

1740-1445/$ – see front matter ß 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.bodyim.2008.11.001
76 S.M. Richardson et al. / Body Image 6 (2009) 75–82
Thus, it is proposed that reducing internalization of the media ideal
will also reduce body dissatisfaction.
Body comparison is the tendency for a person to evaluate his or
her appearance by making comparisons with the appearance of
others (Schutz, Paxton, & Wertheim, 2002). Both girls and boys
engage in body comparisons, which have been found to predict
body dissatisfaction in adolescent girls (Jones, 2004). In light of
these findings, it is likely that reducing body comparisons could
assist in reducing body dissatisfaction.
Appearance teasing has also been found to be a risk factor for
body dissatisfaction in girls and boys (Jones et al., 2004).
BodyThink aims to reduce the incidence of adolescent appearance
teasing and also assist adolescents to cope with such teasing,
therefore reducing body dissatisfaction. Thus, BodyThink aims to
reduce body dissatisfaction and prevent its development by
intervening to reduce a number of different risk factors.
A number of considerations were taken into account when
deciding on appropriate participants for this research. BodyThink
has been delivered in many different settings, including youth
groups and community health centres. However, schools are the
most common location for its delivery in Australia and thus schools
were selected as the best evaluation location.
BodyThink has been delivered to young people between the ages
of 10–17 years, with the most common age group of participants
being 13–15 years. Grade 7 students (approximate range 11–13
years) were selected for this study for a number of reasons. First,
grade 7 is generally the first year of secondary schooling in Victoria,
Australia and consequently it is likely that these adolescents are
making new friendships and establishing group norms. It was
hoped that addressing issues of body image and self-esteem during
this time would contribute to students developing attitudes and
behaviors that foster positive body image and self-esteem amongst
peer groups. Second, it has been argued that interventions should
be implemented before individuals are likely to develop eating
disorders (Paxton, 1993), which most often occurs in adolescents
between 16 and 17 years (Lewinsohn, Striegel-Moore, & Seeley,
2000). Finally, this age group is likely to be experiencing puberty
(Pinyerd & Zipf, 2005), which has been implicated in advancing the
genetic influences on disordered eating (Klump, Perkins, Burt,
McGue, & Iacono, 2007).
Both girls and boys participated in this evaluation as both
genders are affected by body dissatisfaction, they both contribute
to the social environments of the other gender and BodyThink was
specifically designed to address issues relevant to girls and boys.
BodyThink has been designed to be flexible in regard to the time
taken to deliver the program. In this study, BodyThink was
delivered over four 50-min sessions. This decision was based on
practical limitations and previous research that indicates that
multiple session interventions are more effective than single
session interventions (Stice & Shaw, 2004).
In summary, the current study aimed to evaluate the efficacy of
BodyThink, a widely disseminated body image and self-esteem
program. It was hypothesised that those who participated in
BodyThink, compared to participants in the control group, would
report more desirable outcomes on measures of media literacy,
self-esteem, internalization of the media ideal, body comparisons,
appearance teasing and body image. Exploratory analyses were
also conducted to assess if the program had any impact on eating
disorder symptoms.
Method
Participants
Participants were 277, grade 7 students from four public
secondary schools in Melbourne, Australia (M age = 12 years 8
months, SD = 5.58 months). One school was in a low socioeconomic
area, two in medium socioeconomic areas, and one in a medium–
high socioeconomic area. Classes of students were allocated by
teaching staff to either an intervention group (62 girls, 85 boys) or a
control group (65 girls, 65 boys). Class allocation was based on a
variety of reasons, which differed between schools. For instance, at
one school the decision was based on teachers who volunteered
their class to participate in the intervention or control group,
whereas at another schools class allocation was based on avai-
lability of classes at particular times. Fourteen classes of students
took part in the research and each school contributed at least one
class to each group. For girls who reported their weight and height
(n = 79), 12.67% were below the 5th percentile for BMI for their age,
35.44% were between the 5th and 50th percentile, 41.77% were
between the 50th and 85th percentile, 8.86% were between the
85th and 95th percentile and 1.27% were above the 95th
percentile. For boys who reported their weight and height
(n = 114), 8.77% were below the 5th percentile for BMI for their
age, 37.72% were between the 5th and 50th percentile, 34.21%
were between the 50th and 85th percentile, 14.04% were between
the 85th and 95th percentile and 5.26% were above the 95th
percentile. Participants were born in a variety of countries, with
the most common being Australia (83.80%), China (1.4%), England
(1.4%), New Zealand (1.4%) and Sudan (1.4%).
Assessment instruments
Media literacy
Media literacy was assessed by evaluating knowledge about
digital manipulation of images, lighting, camera shoots and the
effect of media images on feelings. Participants were asked to
respond to four statements (‘Before pictures of models are
published in magazines they are digitally manipulated to make
the models look perfect’, ‘Lighting can be used to make a model
look scarier’, ‘The camera never lies’ and ‘There is no evidence to
suggest that media images have an effect on the way people feel
about themselves’) on a 5-point scale from Strongly disagree (1) to
Strongly agree (5). Analysis of internal consistency indicated that
the items were measuring different constructs so responses to each
item are presented separately. Items were scored so that higher
scores corresponded with greater media literacy.
Risk factors for body dissatisfaction
Self-esteem was assessed using the 10-item General Scale of the
Self-Description Questionnaire II (Marsh, 1992). Items (e.g., ‘Overall,
I have a lot to be proud of’) are rated on a 6-point scale ranging from
False (1) to True (6). Modelled on Rosenberg’s Self-esteem Inventory
(Rosenberg, 1965), this scale was designed specifically for use with
adolescents and has been shown to produce reliable and valid scores
in adolescent samples (Marsh). In the current study internal
consistency was high (Girls: a = .91; Boys a = .87).
For girls, internalization of the thin ideal was assessed using the
14-item internalization subscale of the Sociocultural Attitudes
Toward Appearance Questionnaire (Heinberg, Thompson, &
Stormer, 1995). Items (e.g., ‘I believe clothes look better on
thinner models’) are rated on a 5-point scale ranging from Strongly
disagree (1) to Strongly agree (5). The subscale has good
psychometric properties (Jones et al., 2004; Smolak et al., 2001)
and internal consistency in this study was high (a = .87). For boys,
to assess internalization of the muscular ideal, a modified version
of this subscale was used (Smolak et al.). The 14-items (e.g., ‘I
believe that clothes look better on muscular men’) are rated in the
same manner as the original version. This subscale has been found
to have sound psychometric properties for adolescent boys (Jones
et al.; Smolak et al.) and in this study internal consistency was
adequate (a = .85).
 S.M. Richardson et al. / Body Image 6 (2009) 75–82 77

Body comparison tendency in girls and boys was assessed using
the 5-item Physical Appearance Comparison Scale (Thompson,
Heinberg, & Tantleff, 1991), which has been shown to produce
reliable and valid scores in samples of adolescents (Durkin &
Paxton, 2002; Schutz et al., 2002). Items (e.g., ‘At parties or other
social events, I compare my physical appearance to the physical
appearance of others’) are rated on a 5-point scale ranging from
Never (1) to Always (5). In this study, one item (i.e., ‘Comparing
your looks to the looks of others is a bad way to determine if you
are attractive or unattractive’) produced a very low item total
correlation at each time point (range .01 to .03) and was
therefore not included in the scale. The consequent internal
consistency was adequate (Girls: a = .87; Boys: a = .72).
Appearance teasing was assessed using the 6-item Weight
Teasing subscale of the Perception of Teasing Scale (Thompson,
Cattarin, Fowler, & Fisher, 1995). Items (e.g., ‘People made fun of
you because you are heavy’) are rated on a 5-point scale ranging
from Never (1) to Very often (5). This subscale has been shown to
provide reliable and valid scores in samples of adolescents (Lunner
et al., 2000; Schutz et al., 2002). Internal consistency was high in
this study (Girls: a = .93; Boys: a = .94).
Body image and eating disorder symptoms
Body satisfaction was assessed using an adapted version of the
Body Satisfaction Visual Analogue Scale (Durkin & Paxton, 2002).
The original version has 1 item (‘Feel satisfied with your body’),
while the adapted scale has an additional 4-items (e.g., ‘Feel satisfied
with your weight’, ‘Feel comfortable with your body shape’, ‘Feel
satisfied with your appearance’, ‘Feel like an attractive person’).
Participants respond ‘how they feel right now’ by marking a 100 mm
horizontal line anchored by Not at all and Very much so. Individual
responses were measured to the nearest millimetre producing a
numerical score on a 100-point scale. Numerical scores from all
items were summed to create a scale total. The original scale has
been shown to produce reliable and valid scores with adolescent
girls (Durkin & Paxton) and internal consistency was found to be
adequate in this study (Girls: a = .91; Boys: a = .83).
For girls, body dissatisfaction was assessed using the 9-item
Body Dissatisfaction subscale of the Eating Disorder Inventory
(Garner, Olmstead, & Polivy, 1983). For boys, a modified version of
the EDI-Body Dissatisfaction subscale (Jones, 2004) was adminis-
tered, which focused on common areas of male body dissatisfac-
tion (e.g., ‘I think my biceps are too small’), as opposed to the
original version that focuses on common areas of female body
dissatisfaction (e.g., ‘I think my hips are too big’). For both versions,
items are rated on a 6-point scale ranging from Never (1) to Always
(6). These subscales were scored based on the recommendations
for nonclinical samples (Schoemaker, van Strien, & van der Staak,
1994). Both measures have been shown to produce reliable and
valid scores in adolescent samples (Jones, 2004; Jones et al., 2004)
and internal consistency was adequate in this study (Girls: a = .91;
Boys: a = .79).
Dietary restraint was assessed with the Eating Disorder
Examination Questionnaire Restraint subscale (Fairburn & Beglin,
1994). Items (e.g., ‘On how many days out of the past 28 days have
you been deliberately trying to limit the amount of food you eat to
influence your weight or shape’) are rated on a 7-point scale
ranging from No days to Every day. This 5-item subscale has been
shown to provide reliable and valid scores in samples of
adolescents (Wade, Davidson, & O’Dea, 2003). Internal consistency
was adequate in this study (Girls: a = .83; Boys: a = .85).
Bulimic symptoms (e.g., binging, purging) were assessed with
the Eating Disorder Inventory Bulimia subscale (Garner et al.,
1983). This 7-item subscale (e.g., ‘I stuff myself with food’) is rated
on a 6-point scale ranging from Never (1) to Always (6). The
untransformed scoring system was used, which has been shown to
provide reliable and valid scores in samples of nonclinical
adolescents (Schoemaker et al., 1994; Schutz et al., 2002). Internal
consistency was moderate in this study (Girls: a = .74; Boys:
a = .89).
Feedback on BodyThink
Intervention participants were asked to use a 5-point rating
scale ranging from Strongly disagree (1) to Strongly agree (5), to
provide feedback on relevance, interest, enjoyment, comfort and
honesty during the BodyThink sessions. Participants were also
asked to comment on their favourite thing, least favourite thing,
what they would change and to provide additional comments if
desired.
BodyThink program
Table 1 provides an outline of BodyThink’s aims and activities.
BodyThink is an interactive, participant focused program. Topics

Table 1
An outline of BodyThink’s aims and activities.

Aims Activities

Develop an understanding of body image and
self-esteem
Develop awareness that people can have positive body
image and self-esteem regardless of appearance
Increase body satisfaction and self-esteem
Develop an understanding of factors that impact on
body image and self-esteem
Increase media literacy, and reduce internalization of
the media ideal and body comparison
Develop an understanding of the qualities people
appreciate about others
Increase self-esteem, decrease appearance teasing and
improve peer communications
Encourage the continuation of activities that have a
positive impact on body image and self-esteem
Class discussion—‘What is body image and self-esteem?’
Power-point presentation—definitions of body image and self-esteem
Narrative presented by facilitator—the body satisfaction and self-esteem of identical twins
Individual worksheets & class discussion—Brainstorm ways to increase body satisfaction and self-esteem
Class brainstorm & power-point presentation—‘What factors impact on body image and self-esteem?’
Class discussion—‘How do media images make people feel?’
Small group activity & class discussion—‘How do models in magazines feel?’
DVD, power-point presentation, small group activity, individual worksheet & class discussion—the
fabrication of ‘beauty’ and its impact
Class discussion—‘What makes people beautiful?’
Class discussion—‘What is the impact of appearance teasing?’
Small group brainstorm—‘What positive things can you do if you are teased?’
Class discussion—the impact of compliments
Activity in pairs & class discussion—providing written compliments to partner and self
Class activity—participants provide ribbons to each other that represent positive qualities
Class brainstorm & individual worksheet—‘What can I do to continue to assist my body image and self-
esteem?’
78 S.M. Richardson et al. / Body Image 6 (2009) 75–82
addressed include, ‘What is body image and self-esteem?’ ‘Factors
that impact on body image and self-esteem’ and ‘Ways to increase
body satisfaction and self-esteem’. Through the use of materials
such as power-point presentations, magazines, worksheets and a
DVD, participants are encouraged to work together to develop
strategies that empower them to improve their own body image
and self-esteem. BodyThink content is relevant to both girls and
boys, for instance magazine pictures utilised are of both female and
male models.
Procedure
Ethics approval was gained from La Trobe University and the
Department of Education. The evaluation of BodyThink was
conducted by SR and SP with no financial or other support from
The Butterfly Foundation or Dove, with complete independence
and no conflict of interest. JT and DW, who facilitated the program
in classrooms, are both employees of The Butterfly Foundation.
After active informed consent was received from both participants
and a parent/guardian, participants completed baseline question-
naires (T1) in a classroom setting. Participants in the intervention
group then participated in BodyThink. The BodyThink program was
delivered during health classes at two schools, during physical
education classes at another school and during a different class
each time at the fourth school. Each of the four 50 min BodyThink
sessions were generally delivered approximately 1 week apart.
Approximately a week after the completion of BodyThink all
participants completed the Time 2 (T2) questionnaires. All
participants were re-assessed approximately three months later
(M = 93.6days, SD = 34.6days) at Time 3 (T3).
Statistical analyses
Gender differences at baseline were examined using t-tests. As
previous research has found that girls and boys respond differently
to intervention programs (Wilksch et al., 2006), analyses were
conducted separately for girls and boys to examine intervention
effects. Analysis of Covariance (ANCOVA) was utilised for such
analyses because Stice and Shaw (2004) recommend ANCOVA as
an appropriate inferential test of intervention effects. Partial eta
squared (hp2) is the effect size reported for all ANCOVAs. Most
variables met assumptions of ANCOVA, although transformations
were required to improve the normality of self-esteem, appearance
teasing and dietary restraint scores.
In order to compare intervention and the control groups T2
scores after controlling for T1 scores, ANCOVAs were conducted in
which the T1 scores for the relevant variable was entered as the
covariate. Similarly, in order to compare intervention and control
group T3 scores ANCOVAs were conducted on T3 scores in which
T1 of the relevant variable was entered as the covariate. The alpha
level was set at p < .01 for all analyses. Analyses reported in this
paper were conducted using the intention to treat method, as this
technique is a conservative way to analyse the results helping to
prevent the over-estimation of the efficacy of the intervention.
The ANCOVA homogeneity of the regression slope assumption
was violated for a small number of variables (Girls: T3 ‘Digital
manipulation’ and T3 ‘Effect of media images on feelings’; Boys: T2
self-esteem). In these cases an ANOVA was performed using
difference scores (i.e., T1–T2 or T1–T3) because such an approach is
recommended as an alternative to ANCOVA (Tabachnick & Fidell,
2001). When ANOVAs or t-tests were used the effect sizes reported
are eta squared (h2).
ANCOVAs were also conducted to assess if the program had
differential effects depending on participants level of risk. High and
low risk groups for body image were determined by conducting a
tertial split using T1 body dissatisfaction scores, with the first third
of participants considered high risk and the final third of
participants considered low risk. Similarly, high and low risk
groups for self-esteem were determined by conducting a tertial
split using T1 self-esteem scores, with the first third considered
low risk and the final third considered high risk.
Quantitative feedback was analysed by calculating percentages
for each response. To assess if there were any gender differences
for BodyThink feedback the quantitative scores were treated as a
continuous scale and were examined using t-tests. For qualitative
feedback, the first author reviewed all responses and identified
common themes. Responses were then grouped according to these
themes. An independent rater was provided with the themes and a
random selection of responses and was asked to categorise the
responses according to the themes. Inter-rater reliability between
the two raters was moderate to high (weighted kappa = .57).
Results
Participant characteristics
All participants completed T1, 266 participants (96.03%)
completed T2 and 258 participants (93.14%) completed T3
questionnaires. Analyses indicated that there were no significant
differences between participants who returned every question-
naire compared to participants who did not in regard to gender,
age, BMI, country of birth, group (intervention vs. control) or T1
variables. The only significant difference found between the
intervention and control groups at T1 was for girls on the media
literacy item ‘The camera never lies’, with the intervention group
reporting higher scores.
Gender differences at baseline
Analyses revealed that girls reported significantly higher body
comparison (t(219) = 4.47, p < .001, h2 = .069) (girls: M = 9.63,
SD = 4.06; boys: M = 7.69, SD = 2.87), lower body satisfaction
(t(231) = 3.49, p = .001, h2 = .043) (girls: M = 291.46, SD = 121.11;
boys: M = 337.40, SD = 92.12), higher body dissatisfaction
(t(218) = 3.74, p < .001, h2 = .051) (girls: M = 27.88, SD = 9.91;
boys: M = 23.81, SD = 7.16), and higher dietary restraint scores
(t(205) = 3.51, p = .001, h2 = .044) (girls: M = 5.27, SD = 6.78; boys:
M = 2.79, SD = 4.36) compared to the boys. No significant gender
differences were found for the media literacy items, self-esteem,
internalization of media ideals, appearance teasing or bulimic
symptoms.
Examination of the effects of the intervention
Analyses were conducted to assess if there were significant
differences in scores on media literacy, risk factors for body
dissatisfaction, body image and eating disorder symptoms
between intervention and control participants at T2 and T3, after
controlling for T1 (see Tables 2 and 3).
For girls, the intervention group reported significantly higher
media literacy scores than the control group on three of the four
media literacy items at T2 and T3. At T2 the effect sizes were large,
while at T3 they were moderate-large. Furthermore, the inter-
vention group reported significantly lower internalization of the
thin ideal scores at T2, compared to the control group. This effect
size was moderate. Although the differences were not significant
there was a trend towards the intervention group reporting higher
self-esteem scores at T2 and T3, with small-moderate effect sizes.
Also, there was a trend towards the intervention group reporting
lower body comparisons scores at T2 and T3, with small-moderate
effect sizes evident. No significant differences were found between
the groups at either T2 or T3 on the other variables assessed (i.e.,
 S.M. Richardson et al. / Body Image 6 (2009) 75–82 79

Table 2
Means (standard deviations), univariate F values and effect sizes for girls.

Scale T1 T2 T3
range
Intervention M Control M Intervention M Control M F ES Intervention M Control M F ES
(SD) (SD) (SD) (SD) (SD) (SD)

Digital manipulationa 1–5 3.90 (.95) 3.68 (.94) 4.56 (.84) 3.63 (1.14) 22.39*** .160 4.53 (.80) 3.79 (1.18) 8.20** .068
Lightinga 1–5 3.73 (.93) 3.66 (.80) 4.42 (.89) 3.73 (.97) 22.70*** .160 4.26 (1.00) 3.55 (.98) 7.13** .060
Camera shoota 1–5 3.82 (.93) 3.44 (1.01) 4.36 (.91) 3.35 (1.12) 19.85** .140 4.33 (.80) 3.57 (1.11) 11.74** .095
Effect of media images 1–5 3.19 (.94) 3.44 (1.01) 3.54 (1.06) 3.38 (.83) 2.84 .023 3.50 (1.06) 3.40 (.79) 1.68 .015
on feelingsa
Self-esteema 11–66 47.17 (8.89) 47.89 (8.11) 50.11 (7.48) 47.93 (8.90) 6.92y .053 50.66 (9.05) 48.69 (7.73) 5.98y .046
Internalization of 14–70 37.84 (10.18) 38.98 (10.85) 33.77 (8.33) 37.80 (9.76) 8.62** .065 34.31 (10.79) 37.54 (10.88) 3.42 .027
thin idealb
Body comparisonb 5–20 9.50 (3.96) 9.75 (4.18) 7.90 (3.34) 9.38 (4.30) 6.41y .050 8.15 (3.93) 9.49 (3.98) 4.23y .034
Appearance teasingb 6–30 7.80 (2.80) 7.42 (2.98) 7.96 (3.62) 8.12 (4.59) .84 .007 7.63 (3.01) 7.64 (3.18) .80 .006
Body satisfactiona 0–500 278.91 (128.20) 303.23 (113.80) 326.16 (114.81) 309.75 (116.87) .08 .025 319.81 (114.37) 329.89 (116.14) .07 .001
Body dissatisfactionb 9–54 28.27 (11.06) 27.51 (8.79) 26.62 (9.66) 27.67 (9.84) 1.47 .013 26.35 (8.94) 26.31(9.56) <.001 <.001
Dietary restraintb 0–30 4.93 (5.64) 5.58 (7.72) 4.03 (6.60) 5.03 (6.83) 2.54 .020 4.00 (6.55) 4.63 (6.44) 1.11 .009
Bulimic symptomsb 7–42 11.33 (4.09) 11.59 (4.77) 10.48 (4.77) 11.66 (5.80) 1.31 .012 10.09 (4.90) 12.02 (5.82) 2.70 .026

Note. Effect sizes of .01 = small, .06 = moderate, .14 = large (Cohen, 1988).
a
Higher scores are more desirable.
b
Lower scores are more desirable.
**
p < .01
***
p < .001.
y
p < .05

Table 3
Means (standard deviations), univariate F values and effect sizes for boys.

Scale T1 T2 T3
Range
Intervention M Control M Intervention M Control M F ES Intervention M Control M F ES
(SD) (SD) (SD) (SD) (SD) (SD)

Digital manipulationa 1–5 3.48 (.92) 3.63 (1.01) 4.24 (1.12) 3.78 (1.05) 9.75** .064 4.28 (.89) 3.69 (1.08) 18.23*** .120
Lightinga 1–5 3.48 (.88) 3.82 (.95) 3.98 (1.06) 3.81 (1.15) 3.23 .022 3.93 (1.05) 3.74 (1.11) 10.79** .074
Camera shoota 1–5 3.49 (1.18) 3.62 (1.25) 4.13 (1.22) 3.92 (1.15) 1.90 .013 4.06 (1.04) 3.67 (1.30) 4.68y .034
Effect of media images 1–5 3.16 (.92) 3.09 (1.04) 3.78 (1.08) 3.35 (1.05) 5.84y .039 3.32 (1.08) 3.28 (.90) .028 <.001
on feelingsa
Self-esteema 11–66 46.95 (7.68) 48.80 (7.12) 48.98 (8.38) 50.85 (6.43) .020 <.001 48.59 (8.42) 49.14 (7.70) 1.50 .010
Internalization of 14–70 35.69 (8.82) 35.14 (7.79) 31.52 (9.43) 31.55 (9.42) .16 .001 29.92 (10.31) 32.20 (10.23) 3.41 .023
muscular idealb
Body comparisonb 5–20 7.88 (3.03) 7.45 (2.68) 7.84 (3.58) 7.49 (3.22) 2.09 .014 7.84 (3.65) 7.23 (2.74) 2.07 .014
Appearance teasingb 6–30 8.01 (3.46) 7.60 (3.32) 7.84 (3.58) 7.49 (3.22) <.001 <.001 7.84 (3.65) 7.23 (2.74) .43 .003
Body satisfactiona 0–500 332.96 (93.23) 343.30 (91.02) 377.82 (95.63) 352.38 (89.20) 7.91** .051 379.04 (99.02) 353.57 (83.95) 7.40** .048
Body dissatisfactionb 9–54 24.30 (6.95) 23.17 (7.45) 21.74 (7.69) 22.48 (7.28) 1.02 .008 21.50 (7.85) 22.69 (7.50) .99 .008
Dietary restraintb 0–30 2.88 (4.44) 2.69 (4.27) 2.11 (3.47) 2.58 (5.02) .18 .001 1.46 (2.91) 2.42 (4.39) 3.81 .026
Bulimic symptomsb 7–42 12.20 (6.36) 11.33 (5.38) 11.44 (5.80) 10.53 (5.26) .86 .006 10.70 (4.87) 10.41 (5.21) .031 <.001

Note. Effect sizes of .01 = small, .06 = moderate, .14 = large (Cohen, 1988).
a
Higher scores are more desirable.
b
Lower scores are more desirable.
**
p < .01
***
p < .001.
y
p < .05

effect of media images on feelings, appearance teasing, body
satisfaction, body dissatisfaction, dietary restraint and bulimic
symptoms). Also, no significant differences were found between
the intervention and control groups for high risk or low risk (when
risk status was classified according to T1 body dissatisfaction or T1
self-esteem) participants on body dissatisfaction at T2 or T3.
For boys, the intervention compared to the control group
reported significantly higher media literacy for ‘digital manipula-
tion’ at T2, and for ‘digital manipulation’ and ‘lighting’ at T3. These
effects were moderate-large. The intervention group reported
higher body satisfaction scores, than the control group at both T2
and T3, with small-moderate effects demonstrated at both time-
points. Although the differences were not significant there was a
trend towards the intervention group reporting greater knowledge
on ‘effect of media images on feelings’ at T2 with a small-moderate
effect size and on ‘camera shoot’ at T3 with a small-moderate effect
size. No significant differences were found between the groups at
either T2 or T3 on the other variables assessed (i.e., self-esteem,
internalization of the muscular ideal, body comparison, appear-
ance teasing, body dissatisfaction, dietary restraint and bulimic
symptoms). As with the girls, no significant differences were found
between the intervention and control groups for high risk or low
risk participants on body dissatisfaction at T2 or T3. Notably at no
point, for girls or boys, did control participants report significantly
more desirable outcomes than the intervention participants.
Feedback on BodyThink
Table 4 presents intervention participants’ feedback on
relevance, interest, enjoyment, comfort and honesty during the
sessions. The majority of girls agreed or strongly agreed that they
found BodyThink interesting and enjoyable and felt that they could
be honest discussing opinions during the sessions. The majority of
boys reported that they found BodyThink interesting. No significant
differences were found between the feedback provided by girls and
boys for these quantitative items.
80 S.M. Richardson et al. / Body Image 6 (2009) 75–82

Table 4
Intervention participants’ feedback on BodyThink reported in percentages.

Girls (n = 59) Boys (n = 82)

Strongly Disagree Neutral Agree Strongly Strongly Disagree Neutral Agree Strongly
disagree agree disagree agree

I felt comfortable discussing the issues in a group 3.39 5.08 44.07 30.51 16.95 10.97 9.76 43.90 24.40 10.97
with my classmates
I felt that I could be honest about my opinions 1.70 11.87 28.81 32.20 25.42 6.10 8.54 40.24 29.27 15.85
I felt the sessions were relevant to me 13.56 6.78 44.07 23.73 11.86 10.98 18.29 41.46 18.29 10.98
I felt that the sessions were interesting 5.09 6.78 25.42 38.98 23.73 7.32 9.76 32.92 29.27 20.73
I felt that the sessions were enjoyable 5.09 5.09 32.20 27.12 30.50 6.10 4.88 42.68 26.83 19.51

Table 5
Frequencies (percentages) and examples of, the thee most common themes reported by participants who responded to the questions on their favourite thing (Girls n = 59;
Boys n = 72), least favourite thing (Girls n = 58; Boys n = 68), what they would change (Girls n = 59; Boys n = 75) and any additional comments (Girls n = 32; Boys n = 30)
related to BodyThink.

Girls Boys Total

n (%) n (%) n (%)

Favourite thing
The ribbon activity. e.g., ‘‘Getting the coloured ribbons from your classmates. It makes you understand 24 (40.68) 8 (11.11) 32 (24.43)
just how special you are.’’

Activities that related to the manipulation of media images

e.g., ‘‘I like seeing just how much models get changed for a photo. It proved what I thought happened.’’ 6 (10.17) 26 (36.11) 32 (24.43)

Expressing opinions.
e.g., ‘‘My favourite thing about the session was that you could express your opinion freely.’’ 5 (8.47) 8 (11.11) 13 (9.92)

Least favourite thing

I didn’t have a least favourite thing. e.g., ‘‘Sorry I don’t have a least favourite thing I liked it all!’’ 22 (37.93) 23 (33.82) 45 (35.71)

Completing work.
e.g., ‘‘My least favourite thing was the worksheets.’’ 6 (10.34) 18 (26.47) 24 (19.05)

Too much talking or sitting

e.g., ‘‘My least favourite part of the lessons were just sitting down and having to listen.’’ 7 (12.07) 3 (4.41) 10 (7.94)

Change
I wouldn’t change anything. e.g., ‘‘Nothing, it is great as it is.’’ 18 (30.51) 30 (40.00) 48 (35.82)

Make BodyThink more interactive, for instance increase the number of activities or games.
e.g., ‘‘I would have more dvd’s and a bigger slide show. I would get them involved a lot more.’’ 15 (25.42) 20 (26.67) 35 (26.12)

Increase the duration

e.g., ‘‘Making more sessions because that would help us more.’’ 5 (8.47) 3 (4.00) 8 (5.97)

Additional comments
The program was a positive experience. e.g., ‘‘It was good because it helped me see that I’m as pretty as anyone else.’’ 9 (28.13) 16 (53.33) 25 (40.32)
I’d change the program in some way. e.g., ‘‘I’d wished it could have been longer.’’ 8 (25.00) 10 (33.33) 18 (29.03)
I learnt something new and/or enjoyed myself. e.g., ‘‘BodyThink was fun, to learn about how the camera always 10 (31.25) 3 (10.00) 13 (20.97)
lies and how thinking positive is the best thinking’’

Table 5 presents the three most common themes reported by
participants related to their favourite thing, least favourite thing,
what they would change and any additional comments. The ribbon
activity, activities that involved the manipulation of media images
and expressing opinions were the most commonly reported
favourite themes. Participants reporting that they did not have a
least favourite thing and that they would not change the program
were the most common themes for the next two questions
respectively. The other two least favourite themes were complet-
ing work and too much talking or sitting, while suggested changes
included increasing the interactivity and the program’s duration.
The most common theme for additional comments was that the
program was a positive experience. Participants also used this
opportunity to provide information on how the program could be
improved or to indicate that they learnt something or enjoyed the
program.
Discussion
This study aimed to evaluate the efficacy of BodyThink, a widely
disseminated body image and self-esteem program for adoles-
cents. At post-test, girls in the intervention group, compared to the
control group, had more desirable media literacy and internaliza-
tion of the thin ideal scores. At follow-up the difference between
the intervention and control groups was still evident for the media
literacy items. Although not significant, trends suggest that
differences may have emerged between the intervention and
control groups if there was more statistical power on the measures
of self-esteem and body comparison as small-moderate effects
were evident for these variables at both time-points. The large-
moderate effects demonstrated for the media literacy items
suggests that they represent a meaningful change in the girls’
understanding about the ways in which images in the media are
manipulated. Although the findings suggest that the program may
have had an impact on self-esteem, internalization of the thin ideal
and body comparison, these effects were not as strong and thus
require further investigation. For girls, the results did not support
the program having any impact on body image or eating disorder
symptoms.
For boys, at post-test the intervention compared to control
group had more desirable outcomes for ‘digital manipulation’ and
body satisfaction. At follow-up the intervention group reported
 S.M. Richardson et al. / Body Image 6 (2009) 75–82
more desirable outcomes for ‘digital manipulation’ ‘lighting’ and
body satisfaction. Trends suggest that differences may have
emerged between the groups if there was more statistical power
for ‘effect of media images on feelings’ at T2 and ‘camera shoot’ at
T3. The effect sizes for the media literacy items ranged from small-
large and were inconsistent across the time-points suggesting that
the results were not as reliable for the boys as they were for the
girls. The difference between the groups for body satisfaction was
small-moderate, but a corresponding difference in body dissatis-
faction was not observed. This discrepancy in body image findings
may have been because the measure of body satisfaction was more
general (e.g., weight, body, and appearance) while the body
dissatisfaction measure asked about specific body parts (e.g.,
biceps, shoulders, and chest). It is possible that participation in
BodyThink impacted on boys on a macro level, helping improve
overall feelings about appearance (i.e., I feel better about my body),
but did not impact on a micro level (i.e., I am still unhappy with my
biceps). Such results require further investigation. For boys, no
support was found for the program having any impact on risk
factors for body dissatisfaction or eating disorder symptoms.
The program did not appear to have any differential effects
depending on participants’ levels of risk for girls or boys, whether
risk was classified according to T1 body dissatisfaction or T1 self-
esteem. Finally, there was no evidence to suggest that BodyThink
had any iatrogenic effects on girls or boys.
Outcomes for this study are similar to other evaluations of
school-based co-educational body image intervention studies. It
appears that studies that have included measures of intervention
topic knowledge have found effects (Dalle Grave, De Luca, &
Campello, 2001; Kater, Rohwer, & Levine, 2000). However, an effect
on risk factors for body dissatisfaction, body image and eating
disorder symptoms occurs less consistently. For instance, Dalle
Grave and colleagues’ intervention appeared to have an impact on
eating disorder symptoms at post-intervention, but this effect was
not maintained at follow-up and the program did not have any
impact on self-esteem. Similarly, while Wade et al. (2003) media
literacy intervention appeared to have an impact on weight
concern at post-intervention, this effect was not evident at follow-
up and the results indicated that the program did not have any
impact on body satisfaction or dietary restraint. In addition,
Buddeberg-Fischer, Klaghofer, Gnam, and Buddeberg (1998) three
session intervention did not appear to have an impact on any of the
dependant variables assessed, which all related to eating disorder
symptoms. While Kater et al. (2000) and Wilksch et al. (2006)
found some favourable outcomes when evaluating their interven-
tions, they did not include control groups in their research, making
it difficult to interpret the results.
The results of this research and other evaluations of curriculum-
based co-educational interventions indicate that there is scope for
improving such programs and a need for more research. In regard
to BodyThink, a smarter application of the research literature may
be beneficial. For instance, although it is advantageous that
BodyThink attempts to address internalization of the media ideal,
using magazine images of media ideals to address this issue may be
counterproductive given that experimental studies have found
that such exposure contributes to body dissatisfaction (e.g., Durkin
& Paxton, 2002; Durkin, Paxton, & Sorbello, 2007; Farquhar &
Wasylkiw, 2007; Hargreaves & Tiggemann, 2003). Also, while
internalization of media ideals and appearance teasing are well
supported as risk factors for body dissatisfaction in girls and boys,
research has less consistently found such support for self-esteem
and body comparison as risk factors in boys (Jones, 2004; Paxton
et al., 2006a, 2006b). Perhaps, more content addressing risk factors
specific to boys would be beneficial. However, this may be difficult,
as research findings in relation to risk factors in boys are mixed, at
times identifying factors such as pressure from parents and friends
81
to lose weight, BMI and depression as risk factors for body
dissatisfaction, while at other times findings do not support such
factors (Barker & Galambos, 2003; Paxton et al., 2006a; Presnell,
Bearman, & Stice, 2004; Ricciardelli, McCabe, Ball, & Mellor, 2004).
The current evaluation of BodyThink and the limited findings of
other curriculum-based co-educational interventions delivered in
schools highlights the need for greater research in the area and
contrasts with the recent success of female only interventions (e.g.,
Richardson & Paxton, 2008; Stice, Chase, Stromer, & Appel, 2001;
Stice, Trost, & Chase, 2003; Stice, Shaw, Burton, & Wade, 2006;
Stice, Marti, Spoor, Presnell, & Shaw, 2008). A broader school-wide
ecological approach for co-educational settings may be more
desirable and research supporting such a suggestion is beginning
to emerge (e.g., McVey, Tweed, & Blackmore, 2007).
It is very encouraging to see dissemination of appealing
interventions designed to prevent the serious problem of body
dissatisfaction in adolescents. However, while BodyThink may play
a role in improving media literacy, in light of limited resources for
prevention it is important to explore further ways to maximize its
impact. Enhancements to BodyThink which address a wider range
of risk factors for body dissatisfaction may be valuable to explore
and requires further research.
A strength of the current study was that it involved girls and boys,
as few studies have evaluated body image interventions with both
genders (e.g., Buddeberg-Fischer et al., 1998; Dalle Grave et al., 2001;
Kater et al., 2000; McVey et al., 2007; O’Dea & Abraham, 2000; Wade
et al., 2003; Wilksch et al., 2006). Wilksch and colleagues have
suggested that educating boys about the appearance pressures
placed on girls may lead to a reduction in the amount of appearance-
based comments they make to girls. Although the results of this
study provided no evidence to suggest that girls perceived a
reduction in appearance teasing, it is possible that participation in
the program may result in boys communicating more appropriately
with girls on appearance related issues.
Another strength of the study was the inclusion of a follow-up
period which has been absent from some similar evaluations (e.g.,
Kater et al., 2000; Wilksch et al., 2006) and allows some
investigation of the medium-term impact of the program. This
research could be further strengthened by an extended follow-up
period as it is not clear for how long the differences between
groups would have been evident, or indeed if greater differences
may have emerged over time.
Our findings need to be considered in light of methodological
limitations. A notable limitation was non-random allocation of
classes to groups by teachers, which may have introduced a
sampling bias. Efforts were made to control for any pre-
intervention group differences by using T1 variables as covariates,
but any replication of this research would benefit from random
allocation. Also, having intervention and control participants from
the same school can be viewed as a limitation because such a
design provides the opportunity for intervention participants to
share what they learnt with the control participants and may lead
to the intervention participants interacting differently (e.g., teasing
peers less about appearance) in a way that could influence the
control group’s results. The relatively small sample size is another
shortfall of this research, resulting in limited power to detect
difference between groups. Finally, a further limitation was that
some of the assessment instruments asked participants to report
over a time period that exceeded the 1 week delay between the
completion of BodyThink and administration of the T2 question-
naire (e.g., the Eating Disorder Examination Questionnaire
Restraint subscale asks participants to report on the past 28 days).
Future research would benefit from evaluating BodyThink using
more rigorous scientific methods.
In practice, when BodyThink is delivered in Australian class-
rooms there is variety in the gender and profession of the
82 S.M. Richardson et al. / Body Image 6 (2009) 75–82
facilitator, the location of the program, the number of sessions
delivered, the number and age of participants and many other
factors. Thus, future research evaluating BodyThink is warranted to
ascertain the extent to which findings of this study may be
generalised. It is important to note that this study did not observe
any harmful effects of BodyThink. Rather, BodyThink appears to
have an impact on media literacy when implemented in a co-
educational setting.
Acknowledgements
Special thanks to all the school staff and students that were
involved in this research. Thank you also to Danni Watts from The
Butterfly Foundation for her role in the facilitation of BodyThink.
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