Body Image 28 (2019) 53–65

Contents lists available at ScienceDirect

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

From negative to positive body image: Men’s and women’s journeys

from early adolescence to emerging adulthood夽
Kristina Holmqvist Gattario ∗ , Ann Frisén
Department of Psychology, University of Gothenburg, Sweden

a r t i c l e i n f o a b s t r a c t

Article history: This study examined the developmental journeys of individuals who have overcome negative body image
Received 21 June 2018 in early adolescence and developed positive body image on their way to emerging adulthood. Interviews
Received in revised form 6 December 2018 were conducted with 15 women and 16 men (aged 26–27) recruited from a large longitudinal sample.
Accepted 6 December 2018
Results demonstrated different patterns of positive body image development, but most participants had
Available online 21 December 2018
overcome their negative body image by age 18. Factors contributing to their negative body image in early
adolescence included negative peer influence and discontent with life in general. Turning points included
Keywords:
finding a new social context, experiencing agency and empowerment, and using cognitive strategies to
Negative body image
Positive body image
improve body image. Characteristics of the participants’ current positive body image coincided with
Body appreciation established features of positive body image; novel findings were that the women were more likely to
Body image development think of positive body image as needing constant work to maintain and were also more likely to have
Turning points a feminist identity, whereas the men were more likely to try to improve their body shape and perceive
Qualitative research their body as resembling the ideal. In conclusion, body image interventions need to target not only
Bullying matters related to physical appearance but also adolescents’ general sense of belonging, agency, and
empowerment.
© 2018 Elsevier Ltd. All rights reserved.

1. Introduction
Negative body image, conceptualized as poor body esteem,
body dissatisfaction, or body shame, dramatically affects the lives
of many young people as it is linked to low overall well-being
(Meland, Haugland, & Breidablik, 2007), low self-esteem (Davison &
McCabe, 2006), depression (Ohring, Graber, & Brooks-Gunn, 2002),
and disordered eating (Westerberg-Jacobson, Edlund, & Ghaderi,
2010). Adolescence is a critical time for body image develop-
ment as many of the changes during this phase in life (biological,
emotional, cognitive, as well as social) channel individuals’ atten-
tion towards their developing physical bodies. The few large-scale
longitudinal studies examining long-term body image develop-
ment demonstrate that most adolescents experience a dramatic
increase in negative body image in early adolescence (Bucchianeri,
Arikian, Hannan, Eisenberg, & Neumark-Sztainer, 2013; Eisenberg,
夽 This research was supported by grants from the Swedish Research Council for
Health, Working Life and Welfare (grant number 2014-1729). We thank Åsa Nord-
ström for assisting in the data collection and the participants for sharing their stories.
∗ Corresponding author at: Department of Psychology, University of Gothenburg,
Box 500, 405 30 Gothenburg, Sweden.
E-mail address: kristina.holmqvist@psy.gu.se (K.H. Gattario).
Neumark-Sztainer, & Paxton, 2006; Frisén, Lunde, & Berg, 2015)
and maintain their negative body image throughout adolescence
and into emerging adulthood (Frisén et al., 2015; Rogers, Webb, &
Jafari, 2018). Body image in emerging adulthood tends to remain
stable (Grogan, 2017). Altogether, these findings indicate that the
adolescent years are critical for many in shaping the body image
that they will subsequently carry with them into adulthood.
Although the most common developmental pattern implies
a drastic increase in negative body image in early adolescence
followed by stability into emerging adulthood, investigations of
individual trajectories demonstrate that there are also other pat-
terns of body image development (Frisén et al., 2015; Nelson,
Kling, Wängqvist, Frisén, & Syed, 2018; Rogers et al., 2018). One
particularly interesting pattern, explored further here, pertains to
individuals who, consistent with the majority, develop negative
body image in early adolescence, but who then overcome their neg-
ative body image and develop positive body image on their journey
to emerging adulthood. We are unaware of any in-depth study of
this interesting developmental pattern, although the experiences
of individuals following this trajectory may be of particular value to
body image research, prevention, interventions, and clinical work.
Indeed, these individuals have managed to overcome a negative
body image and their experiences of their journey toward a pos-

https://doi.org/10.1016/j.bodyim.2018.12.002
1740-1445/© 2018 Elsevier Ltd. All rights reserved.
54 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
itive body image can be helpful in distinguishing the factors that
may help turn a negative body image into a positive one.
This study will accordingly explore men and women’s develop-
ment from a negative body image in early adolescence to a positive
body image in emerging adulthood. One focus of this study is to
examine the range of individual patterns of body image develop-
ment that these men and women display. For example, does the
change from negative to positive body image tend to happen grad-
ually or does it take dramatic turns and, if so, when? Answering
these questions will advance our understanding of positive body
image development and provide valuable information about the
stage at which interventions should be implemented. Another focus
is to investigate the factors underlying this pattern of development
from a negative body image in early adolescence to a positive body
image in emerging adulthood. Specifically, what contributed to
the participants’ negative body image in early adolescence? What
characterized their positive body image in emerging adulthood?
Perhaps most importantly, what were the turning points in their
development? The answers to these questions can provide valu-
able knowledge of the factors characterizing negative body image
that can be overcome, the factors that can help turn this negative
body image into a positive body image, and the characteristics of
positive body image that have been acquired.
Several theoretical perspectives can help us understand the
factors underlying individuals’ body image development. The dom-
inant theoretical models (e.g., Smolak, 2012; Thompson, Coovert,
& Stormer, 1999), however, tend to focus on the risk factors
undermining body image development and do not specifically
reflect on those that may promote positive body image (Tylka
& Wood-Barcalow, 2015b). For years, it was assumed that posi-
tive body image was simply the opposite of negative body image,
and the factors assumed to promote positive body image were
therefore simply seen as the opposites of those undermining
body image (Striegel-Moore & Cachelin, 1999). However, recent
research into positive body image has provided evidence that this
picture may be too simplistic. The few studies exploring the expe-
riences, thoughts, attitudes, and behaviors of individuals with a
positive body image have been helpful in conceptualizing pos-
itive body image as featuring body appreciation, functionality
appreciation, body acceptance, inner positivity, interpreting infor-
mation in a body-image–protective manner, and conceptualizing
beauty broadly (Alleva, Tylka, & Kroon Van Diest, 2017; Frisén
& Holmqvist, 2010b; Holmqvist & Frisén, 2012; Wood-Barcalow,
Tylka, & Augustus-Horvath, 2010). Yet, previous studies have not
specifically examined individuals’ journeys toward a positive body
image and have therefore not considered the factors that may help
turn a negative into a positive body image. In addition, previous
studies have focused on adolescent girls’ and young women’s expe-
riences of having a positive body image; in fact, only one sample of
adolescent boys has previously been studied (Frisén & Holmqvist,
2010b; Holmqvist & Frisén, 2012). This indicates a lack of knowl-
edge of young men’s positive body image and how it may differ
from young women’s. This study accordingly adds to the litera-
ture by examining patterns of positive body image development in
young men as well as women. In addition, it is the first study to
qualitatively examine what characterizes positive body image in
young men.
When it comes to understanding the factors that can promote
positive body image, specifically, theoretical models are still in their
infancy (Halliwell, 2015). Longitudinal, quantitative studies have
contributed insights into what can promote body appreciation, one
of several aspects of positive body image, which is defined as indi-
viduals’ acceptance of, favorable opinions of, and respect for their
bodies (Tylka & Wood-Barcalow, 2015b). For example, the accep-
tance model (Avalos & Tylka, 2006) suggests that social support
and body acceptance by others are important factors promoting
body appreciation (Andrew, Tiggemann, & Clark, 2016; Augustus-
Horvath & Tylka, 2011; Avalos & Tylka, 2006; Tylka & Homan, 2015).
This model emphasizes the importance of support and acceptance
from others in promoting positive body image, but it provides little
information about whether and how these aspects may play a role
in turning a negative body image into a positive one. Also, there may
be additional factors serving as turning points that are not covered
in the model. Another theoretical model, the developmental theory
of embodiment (2017, Piran & Teall, 2012; Piran, 2016), suggests that
positive embodied experiences, that is, activities that enhance the
awareness of bodily experience, connectedness with the body, and
feelings of competence, empowerment, and inclusion, can promote
positive body image. While this model has a wider scope than does
the acceptance model, a deficiency is that it was developed based on
assessments of girls and women only, and more research is needed
to evaluate the application of the embodiment construct in young
men.
The acceptance and developmental theories of embodiment
provide a preliminary idea of factors that may turn a negative body
image into a positive one, but turning points need to be exam-
ined more thoroughly, through studies including both men and
women. To obtain a deeper understanding of men’s and women’s
journeys from negative to positive body image, it is essential to
hear the stories of the individuals who have followed this particu-
lar developmental trajectory. Their reflections on their own body
image journey can be valuable in order to identify factors with the
potential to change the path of body image development and to
understand individual body image trajectories.
1.1. Aim and research questions
The aim of this study was to examine young men and women’s
development from a negative body image in early adolescence to
a positive one in emerging adulthood. Four specific research ques-
tions guided the investigation: (a) What are the different patterns of
body image development displayed by individuals who start with
a negative body image in early adolescence and then acquire a pos-
itive one on their way to emerging adulthood?; (b) What factors
contributed to their negative body image in early adolescence?; (c)
What factors served as turning points in their body image devel-
opment?; and (d) What characterized their positive body image in
emerging adulthood?
2. Method
2.1. Participants
The participants, 15 women and 16 men (Mage = 26.19,
SD = 0.48), were recruited from the longitudinal research project
MoS (Mobbning och Skola [Bullying and School]), which has stud-
ied individuals’ body image development from ages 10 to 24 years
(see, e.g., Frisén & Holmqvist, 2010a; Frisén et al., 2015; Gattario
et al., 2015; Lunde & Frisén, 2011). In the first wave, 960 10-year-
olds participated (515 girls and 445 boys). There have been in total
six waves in the study, at ages 10, 13, 16, 18, 21, and 24 years.
Rates of attrition have overall been low: 91% (n = 874) of the origi-
nal sample participated at age 13 years, 79% (n = 758) at age 16, 74%
(n = 715) at age 18, 64% (n = 607) at age 21, and 56% (n = 544; 302
women and 242 men) at age 24.
In this longitudinal project, body image has been assessed
using the Body-Esteem Scale for Adolescents and Adults (BESAA;
Mendelson, Mendelson, & White, 2001 see Measures). To recruit
participants to the present study, we used the mean score of the
BESAA Appearance and Weight subscale items, since the Attribu-
tion subscale has displayed lower reliability than have the other
two subscales (Mendelson et al., 2001). Expectation maximization
 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65 55

in SPSS was used to handle missing data when participants had

fewer than four missing values on the BESAA on one occasion. Those
recruited to this study met the inclusion criteria of (a) having par-
ticipated in at least four of the six waves of the study, (b) having
had low body esteem in early adolescence (ages 10 and 13 years),
and (c) having high body esteem in emerging adulthood (age 24
years). Negative body image (at ages 10 and 13 years) and positive
body image (at age 24 years) were defined relative to the BESAA
scores of the larger longitudinal sample at those same ages. At each
age, all participants were divided into four quartiles ranging from
those with low body esteem (first quartile) to those with high body
esteem (fourth quartile). We defined negative body image as hav-
ing a BESAA score in the first or second quartiles, that is, lower than
the median of the total sample (at age 10, < 3.46 for boys and <
3.30 for girls, and, at age 13, < 3.14 for boys and < 2.60 for girls).
We defined positive body image as having a BESAA score in the
fourth and highest quartile (at age 24, > 3.13 for men and > 2.96
for women). From a developmental perspective, we considered the
participants’ relative position in body esteem in relation to their
Fig. 1. Female participants’ body image development (as measured combining
same-age peers a better indicator of their body image than using BESAA Weight and Appearance; Mendelson et al., 2001) between ages 10 and 24
identical cut-off points for positive and negative body image at all years. The median (dotted line) is from the larger longitudinal sample of partici-
ages. pants (N = 960) from which the current sample was recruited. BESAA ranges from 0
For consistency, throughout this paper we refer to individu- to 4, with higher values indicating a more positive body image.
als’ negative body image ‘turning into’ a positive one; however,
negative body image and positive body image should not be consid-
ered opposites of one another, and aspects of negative body image
may co-exist with positive body image (Tylka & Wood-Barcalow,
2015b). Yet, when examining body image development over time
as in this study, it is necessary to be consistent in our conceptualiza-
tions of body image from wave to wave in order to study changes in
development. Therefore, for the recruitment of participants to this
study, we defined both negative and positive body image according
to their levels of body esteem.
In total, 25 men and 30 women met the inclusion criteria of
having had negative body image in early adolescence and having
positive body image in emerging adulthood. We set a predefined
goal of including 30 participants (15 men and 15 women) in
the study. Hence, we regularly contacted small sets of randomly
selected participants from the 25 men and 30 women until we had
achieved this goal. The final sample consisted of 16 men and 15
women. Their BESAA scores at age 10 years ranged from 1.95 to
3.89 (M = 3.18, SD = 0.52) for boys and 2.37–3.53 (M = 2.90, SD = 0.37)
for girls; at age 13 years 1.43–3.95 (M = 2.98, SD = 0.75) for boys
Fig. 2. Male participants’ body image development (as measured combining BESAA
and 1.00–3.95 (M = 2.75, SD = 0.75) for girls; and at age 24 years Weight and Appearance; Mendelson et al., 2001) between ages 10 and 24 years. The
3.23–3.70 (M = 3.44, SD = 0.14) for men and 2.94–4.00 (M = 3.34, median (dotted line) is from the larger sample of participants (N = 960) from which
SD = 0.34) for women. For further illustration of their body esteem the current sample was recruited. BESAA ranges from 0 to 4, with higher values
at different ages, see Figs. 1 and 2. Demographic data from age 24 indicating a more positive body image.
years demonstrated that the participants’ highest educational level
ranged from lower secondary school (n = 1), upper secondary school tioned from a negative to a positive body image) until right before
(n = 11), university degree initiated (n = 13), to university degree fin- the fifth and final part (e) of the interview, to prevent this informa-
ished (n = 6). The majority of the participants were born in Sweden tion from affecting how they described their body image journey.
(n = 29) and the remaining were born in other European countries Within a week of the participants’ receiving the information let-
(n = 1) or in the Middle East (n = 1). Six of the participants had par- ter, we contacted them by telephone to ask whether they agreed
ents that were born in other countries than Sweden, mainly other to take part in the study. We used the contact information they
European countries (n = 3) and the Middle East (n = 3). Twenty- had supplied online during their previous participation in the lon-
five of the participants identified as heterosexual, one as gay, four gitudinal study. As an incentive, participants were offered two
as bisexual, and one participant preferred not to report his or her movie tickets as well as a book published by the authors, which
sexual orientation. describes many of the previous findings of the longitudinal research
project (Frisén, Holmqvist Gattario, & Lunde, 2014). Written con-
2.2. Procedure sent was collected from each participant before the interview. Most
participants were interviewed at the Department of Psychology,
Eligible participants first received a written letter with informa- University of Gothenburg, in a setting made as comfortable as pos-
tion about the study. The study aim described in the information sible for them. If the participants lived in another city, we arranged
letter was “to gain a richer understanding of people’s thoughts to meet with them at a suitable place in their area (in total, eight
and feelings about their bodies.” Participants were not informed men and five women). Interviews were audio recorded and lasted
of their BESAA developmental pattern (i.e., that they had transi- approximately 1.5 h. To ensure that the participants still had a
56 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
positive body image at the time of the interview, which occurred
approximately two years after the age 24-year time point in the lon-
gitudinal study, participants were asked to fill in measures of body
esteem and body appreciation in-between part (b) and (c) of the
interview. After the interview, there was a short debriefing where
participants were asked about how they experienced the interview
and were able to ask questions about the study. The data collection
was approved by the Regional Ethical Review Board in Gothenburg,
Sweden, project name “Bullying and Body Image – A Longitudinal
Study From Childhood to Adulthood,” protocol number T446-15.
2.3. Semi-structured interview
An interview schedule was constructed in accordance with the
guidelines provided by Smith and Osborn (2003). The interview
topics were based on the existing body image literature, but also
included parts that were more explorative. The different parts of
the interview assessed: (a) a general idea of the participant’s cur-
rent body image, (b) participants’ reflections on the influence of
family and peers on their body image when growing up, (c) par-
ticipants’ reflections on a picture of themselves that they liked and
that they were asked to email us before the interview (this was also
included to promote discussion of the participants’ current body
image), (d) participants’ reflections on appearance ideals conveyed
in the media, and (e) participants’ reflections on their body image
journey. The questions for each part are presented in Appendix A.
Introductory questions (e.g., regarding family and peer group con-
stellations when growing up) were asked to help the participants
remember their life as adolescents. Several unstructured questions
were asked to follow up the different aspects raised by the par-
ticipants. The following definition of body image was provided at
the beginning of the interview: “Body image includes experiences,
feelings, attitudes, and behaviors in relation to the body. It can
relate to the body’s appearance, function, as well as health. Peo-
ple may differ in the importance they ascribe to these different
aspects of their body image.” Right before the fifth and final part
(e) of the interview where participants were asked to reflect on
their own body image journey, participants were informed that
they belonged to a group of participants who, in relation to the
large longitudinal sample, had a negative body image in early ado-
lescence and then had developed a positive one on their way to
emerging adulthood.
Two pilot interviews, conducted to discern any potential con-
cerns with the interview, allowed the two interviewers (the first
author and a trained research assistant with a Degree of Master
of Science in Psychology) to discuss their biases. Both interview-
ers were 35-year-old females with experience in semi-structured
interviewing and that were unknown to the participants.
2.4. Measures
2.4.1. Body esteem
The BESAA (Mendelson et al., 2001), translated into Swedish
(Erling & Hwang, 2004), was used to quantitatively assess partici-
pants’ body image throughout the broader longitudinal project as
well as at the time of the interview. The BESAA consists of 23 items
that can be divided into three subscales: Weight (weight-based
body esteem; eight items; e.g., “I really like what I weigh”), Appear-
ance (appearance-based body esteem; 10 items; e.g., “I like what
I look like in pictures”), and Attribution (beliefs about how others
view one’s body and appearance; five items; e.g., “People my own
age like my looks”). Respondents indicate their degree of agreement
with each statement on a Likert scale ranging from 0 = never to 4 =
always, with higher scores indicating higher body esteem. For the
present study, we used only the items on the Weight and Appear-
ance subscales to create a mean score of the BESAA, because the
Attribution subscale has demonstrated lower reliability than the
other two subscales (Mendelson et al., 2001). The two subscales
have, in previous studies, displayed high internal consistency and
test-retest reliability among Canadian adolescents and emerging
adults (Mendelson et al., 2001). In the large longitudinal sample,
reliability scores for the Weight subscale ranged from ␣ = .90 to .94
and for the Appearance subscale from ␣ = .89 to .92 at ages 10 to 24
years.
2.4.2. Body appreciation
The Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow,
2015a) was used to quantitatively assess body appreciation. The
BAS-2 has a unidimensional factor structure and consists of 10
items measuring individuals’ acceptance of, favorable opinions of,
and respect for their bodies (e.g., “I appreciate the different and
unique characteristics of my body”). Respondents indicate their
degree of agreement with each statement on a Likert scale ranging
from 1 = never to 5 = always. Item scores are averaged, with higher
scores reflecting higher levels of body appreciation. The BAS-2
has, in previous studies, displayed high internal consistency, test-
retest reliability, and construct validity, among U.S. community and
undergraduate women and men (Tylka & Wood-Barcalow, 2015a).
To translate the BAS-2 into Swedish (see Appendix B), the scale was
translated by the first author and then back-translated by a research
assistant (Brislin, 1970). The translations and backtranslations were
reviewed and discussed until we agreed on the translation that we
considered most adequate and relevant. The scale was pilot-tested
before data collection. Lemoine et al.’s (2018) recent evaluation of
an almost identical version of the Swedish BAS-2 that they based
on our translation, demonstrated excellent psychometric proper-
ties in a sample of Swedish-speaking adolescents and young adults.
The reliability score in our sample was ␣ = .83.
2.5. Analyses
To answer research question (a) regarding the participants’ dif-
ferent patterns of body image development toward a positive body
image, their body esteem scores from ages 10 to 24 years were
extracted from the longitudinal database. Based on these scores,
we created graphs illustrating the 31 participants’ individual body
esteem patterns; see Figs. 1 (women) and 2 (men). We also cal-
culated their body esteem and body appreciation scores collected
at the time of the interview. To answer research questions (b) to
(d), thematic analysis was used. Thematic analysis is used for the
systematic identification and analysis of patterns, or themes, in
data (Braun & Clarke, 2006). In the present study, research ques-
tions (b) to (d) guided the analysis so that the themes identified
should reflect (b) what contributed to the participants’ negative
body image in early adolescence, (c) what the turning points were
in their development, and (d) what characterized their current
positive body image. Three thematic analyses were accordingly
conducted, one for each research question. The two authors started
by separately reading the interview transcripts to become famil-
iar with the data, assigning initial codes to meaningful features.
During this process, the authors met regularly to discuss poten-
tial patterns and themes in the data. After having read the first 12
transcripts, the authors met and agreed on a preliminary coding
scheme that the first author then used to code the remaining inter-
views. The two authors had regular contact during this process to
discuss any necessary adjustments to the coding scheme. Only a
few small adjustments were made to the preliminary scheme.
Two individual case stories (one woman and one man) were
chosen to illustrate the participants’ different body image journeys
and portray the range of themes distinguished in their stories (see
Appendix C).
 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
3. Results
The first part of this section presents the participants’ body
image development in quantitative terms. This includes descrip-
tions of their body esteem as measured using BESAA from ages 10 to
24 years. It also includes their body esteem and body appreciation
scores at the time of the interview. The second part of this section
illustrates the participants’ body image in qualitative terms. We
present the results of the thematic analysis and use fictive names
to illustrate the themes.
3.1. Patterns of development from a negative body image in early
adolescence to a positive body image in emerging adulthood
The participants’ body esteem development from ages 10 to 24
years are illustrated in Figs. 1 (women) and 2 (men). The median
at each age (indicated by a dotted line) is from the larger sam-
ple of participants (N = 960) from which the current sample was
recruited. In line with the inclusion criteria, all 31 participants’
body esteem values were below the median at age 10 and/or 13
years and in the positive quartile at age 24 years. Although the par-
ticipants were recruited based on the same inclusion criteria, the
graphs show a range of individual patterns in the sample, provid-
ing brief preliminary insight into their many different trajectories
from a negative to positive body image. Some participants expe-
rienced dramatic turns, both positive and negative, in their body
image development before they finally stabilized around a more
positive body image. Others experienced a steadier, gradual pos-
itive development toward a positive body image. Interestingly, a
few participants did not experience any increase in body esteem,
but rather maintained a similar level of body esteem while the
larger longitudinal sample to which they were compared gener-
ally became more negative; this, in turn, resulted in the current
sample’s more positive relative position. Note that most partic-
ipants (11 women and 12 men) already reported above-median
body esteem at age 18 years, overcoming negative body image
according to the definition used here. However, it takes until the
last measurement at age 24 for all participants to be in the most
positive quartile. Clearly, however, age 18 seems to be the time by
which most participants have acquired a more stable body image
(no one is in the lowest quartile at this age) and have started their
process of developing toward, or even maintaining, a positive body
image.
3.2. Participants’ body esteem and body appreciation at the time
of the interview
Participants generally displayed high levels of body esteem at
the time of the interview, indicating that they had maintained their
positive body image from the 24-year measuring point. Women’s
body esteem scores ranged from 2.50 to 3.78 (M = 3.16, SD = 0.42).
Men’s body esteem scores ranged from 2.94 to 3.50 (M = 3.28,
SD = 0.17). If we compare the participants’ body esteem at the time
of the interview with the cutoff value used for recruiting them (i.e.,
BESAA scores > 2.96 for women and > 3.13 for men), two women
and three men reported body esteem scores slightly below these
cutoffs at the time of the interview. They were retained in the anal-
ysis, however, because all of them displayed relatively high levels
of body appreciation (> 3.60).
The participants generally displayed high levels of body appre-
ciation at the time of the interview, further indicating their current
positive body image (Tylka & Wood-Barcalow, 2015b). Women’s
body appreciation scores ranged from 3.60 to 5.00 (M = 4.35,
SD = 0.45). Men’s body appreciation scores ranged from 3.30 to 4.90
(M = 4.34, SD = 0.44). Compared with mean values of body appreci-
ation previously obtained in U.S. community samples of men and
57
women (M for men = 3.46, SD = 0.86, M for women = 3.22, SD = 0.96;
Tylka & Wood-Barcalow, 2015a), the present participants had sig-
nificantly higher body appreciation, both men t(203) = –3.92, p <
.01, and women t(205) = –4.51, p < .01. These results further demon-
strate that the present sample experienced positive body image
in line with recent conceptualizations (Tylka & Wood-Barcalow,
2015b), and not only high levels of body esteem.
3.3. Thematic analyses: the participants’ own descriptions of
their body image development
3.3.1. What factors explained the participants’ negative body
image in early adolescence?
The factors forming the participants’ negative body image
in early adolescence were: the perception of having a deficient
appearance relative to peers, experiences of negative peer influ-
ence, and experiences of overall discontent and lack of self-esteem
extending to the participants’ body image.
3.3.1.1. Perception of having a deficient appearance (13 men, 11
women). The majority of the participants experienced having a
deficient appearance relative to peers in early adolescence (e.g.,
having been shorter, taller, chubbier, larger, or thinner than peers,
or having protruding ears, bad acne, braces, or too-small or too-
large breasts). Some participants expressed that their perceived
deficient appearance was related to maturing early or late in terms
of puberty. Emma, for instance, said, “I was a bit chubby right before
puberty and during high school. I felt like I wasn’t good enough.”
3.3.1.2. Experiences of negative peer influence (11 men, 11 women).
The majority of the participants also experienced peer appearance
teasing or even physical (e.g., being hit, pushed, or kicked) or ver-
bal (e.g., being called nasty names) bullying at school. Appearance
teasing often targeted the features of the participants’ appearance
perceived as deficient by the participant. Jakob said, “I was always
teased about my height. Everyone else was like one head taller than
me so that was something they always commented on.” Kristoffer
said, “People have hit me and spit on me. I’ve always been bul-
lied, from the first day I went to school.” The theme also includes
a few descriptions by participants who experienced high appear-
ance pressure in their peer group at school. Jenny had a close friend
who was very appearance-oriented and influenced her to engage
in disordered eating: “She said that if she would be as tall as me,
she would be thinner. Because then she would want to be a model.
[. . .] She used toothbrushes to try to throw up food. So I tried it too.
[. . .] Her eating disorder was somehow transmitted on to me.”
3.3.1.3. Overall discontent and lack of self-esteem extended to body
image (8 men, 7 women). Several participants felt discontent with
life in general and experienced low self-esteem in early adolescence
and this, in turn, extended to their body image. The theme also
includes experiences of having difficulties finding oneself or one’s
place in life during early adolescence, or general feelings of fail-
ure and psychological ill-being. A shared feature of the experiences
within this theme is that they are not directly related to the partic-
ipant’s physical body, but still influence body image through their
impact on the participant’s life and well-being in general. Karl, for
instance, experienced difficulties at school because he had dyslexia,
and when asked about his negative body image at this time he said,
“I think it had to do with all of it. I wasn’t too happy about myself
at all at that time.”
3.3.2. What factors served as turning points in the participants’
body image development?
We identified three factors that served as turning points in the
participants’ development from a negative body image to a pos-
58 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
itive one: the participants found a social context in which they
felt belonging and acceptance, the participants developed a sense
of agency and empowerment in their lives, and the participants
started to actively use strategies to improve their body image. We
coded for turning points when the participants described events
or new ways of thinking that changed the direction of the partici-
pants’ life story. Although turning points were mostly identified on
the basis of the participants’ reflections of their body image jour-
ney, they were also identified on the basis of events or new ways of
thinking that they described occurred between their negative and
positive body image. We identified more than one turning point in
most participants’ interviews, so the themes may overlap.
3.3.2.1. Participants found a social context in which they felt belong-
ing and acceptance (13 men, 11 women). Many participants said that
having found a new social context in which they felt belonging
and acceptance had been essential for their positive body image
development. The new social context was provided by support-
ive and like-minded friends as well as affirmative and encouraging
romantic partners.
3.3.2.1.1. Friends who were supportive and like-minded (10 men,
6 women). Many participants described how finding friends who
were similar to them in their interests and/or personality repre-
sented a turning point for them. By feeling supported and accepted
by peers and experiencing belonging, the participants became more
confident in their bodies and their body image. Kristoffer, who had
been bullied at school, described how finally finding new friends
was a turning point for him: “After having gone through a long
time of no positive [input] at all, I found people who respected me,
who said that ‘you’re OK and we like you for who you are.’ [. . .]
To me, it was like finding another family outside of my [original]
family. I found a place where I was accepted and I felt like ‘wow,
this is where I belong.’”
3.3.2.1.2. Affirmative and encouraging romantic partners (5 men,
5 women). Some participants described meeting a boyfriend or a
girlfriend who, by giving encouraging appearance-reassuring com-
ments, helped the participants to be more comfortable in their
body. Sara described how her first boyfriend in ninth grade was
a real “boost” to her body image: “I had a lot of acne at the time
and couldn’t for the world understand why he still wanted to be
with me, even though my face was full of acne. But he wanted to,
and we were so in love.” Other participants described how having
a partner with whom they could discuss difficult matters and that
listened to them was a relief when experiencing negative feelings.
3.3.2.2. Participants developed a sense of agency and empowerment in
their lives (13 men, 10 women). For the majority of the participants,
positive body image development was also related to experiences
of increased agency and empowerment.
3.3.2.2.1. Agency through the body (11 men, 10 women). Several
participants started to use their body as a means to feel agency
and control in life. Most frequently, this was related to excelling
in physical activities or sports or, less frequently, in other body-
related activities (e.g., singing or exploring one’s sexuality). Elin
said, “When I started training and dancing, that affected me a lot in
the sense that I got a more positive. . . more control over my body.”
A few women described using small acts of body activism (e.g.,
refusing to shave one’s legs) to gain power and control. This theme
also includes descriptions of exploring and eventually finding one’s
own personal style in clothing and grooming, and how this helped
the participants to feel more confident in their bodies. Oskar, for
instance, said, “I feel like I found a clothing style that fits with my
body. And that has made me feel good about my clothes as well as
the way I look.”
3.3.2.2.2. A general sense of agency and empowerment in one’s life
(7 men, 8 women). Some participants developed a general sense of
agency and control in life not directly related to their body. Several
participants succeeded at work or in their studies and, by doing
so, felt competent and gained self-esteem, which extended to their
body image. Karl, for instance, who had difficulties succeeding in
school because of his dyslexia, told us about how eventually man-
aging to get employed had a positive impact on his whole life: “It
[school] was a real struggle for me. And then, when I managed to
get a job, and then another job, and things started going well. . .
Everything just fell into place.” A few participants also described
the empowerment they felt when they became adults and were
finally able to make decisions for themselves.
3.3.2.3. Participants started to actively use strategies to improve their
body image (12 men, 6 women). Many participants also described
using various strategies to improve their negative body image:
practicing body acceptance, avoiding or ignoring negative body-
related information, focusing on other things in life, and realizing
that pursuing the ideal means having to sacrifice other things in
life.
3.3.2.3.1. Practicing body acceptance (7 men, 4 women). Sev-
eral participants tried to think of their body imperfections as part
of themselves and began to accept their bodies. Simon, who had
received negative comments about the size of his ears, said, “If you
would tell me now that I have small ears I would say ‘Ok, what am I
supposed to do about that? I have small ears. It’s not like I can make
them bigger.’”
3.3.2.3.2. Avoiding or ignoring negative body-related information
(1 man, 2 women). A few participants started to actively avoid
or ignore negative body-related information, including appearance
comments from peers and media images promoting the appearance
ideal. Amanda said, “I’ve done some pretty drastic choices in my life
because of this thing with my body. . . I don’t read the blogs I used
to read. I don’t watch the TV-programs I used to watch. Because I
noticed that they make me feel uncomfortable with my body.”
3.3.2.3.3. Focusing on other things in life (8 men, 7 women). Sev-
eral participants started to pay attention to other things than their
physical appearance. Instead, they focused on having a nice per-
sonality, being healthy, developing their intellect, learning new
things, doing well at work, or more generally “other more impor-
tant things.” Linnea said, “You need to let go of that constant focus
on the body. It’s not useful to sit at home and read a magazine. It
won’t help increase your self-esteem.”
3.3.2.3.4. Realizing that pursuing the ideal means having to sac-
rifice other things in life (7 men, 1 woman). A strategy that was
brought forward almost exclusively by the young men was real-
izing that pursuing the appearance ideal was too strenuous and
time-consuming and entailed giving up certain pleasures in life
(e.g., food and drink). This ultimately led the participants to stop
pursuing the ideal and become more satisfied with their bodies.
Lukas told us that he regularly worked out, but that the goal of
his training had changed over time: “I now exercise in order to
feel good. That’s what’s important, not because I want big arms or
abdominals or anything. That is such a waste of time. [. . .] I would
have to quit my job in that case. It was different when I was a stu-
dent and [I thought] ‘I want a six-pack, and I want all of that’. . . and
now it’s more important for me to feel good.”
3.3.3. What characterizes the participants’ positive body image in
emerging adulthood?
Several features were identified as characteristics of the par-
ticipants’ current positive body image. These included body
appreciation, perception of the body as integral to the self, body
acceptance, body attunement and self-care, mentoring others
to like their bodies, filtering media images in a body-image-
protective manner, constantly practicing positive body image,
feminist approach to body image, appearance-enhancing invest-
 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
ment, and the perception of having a body that is close to the
ideal.
3.3.3.1. Body appreciation (12 men, 12 women). The majority of the
participants expressed appreciation of the features, functionality,
and health of their bodies. Some participants, like Elin, had friends
with health problems or experienced health problems themselves
(e.g., back pain), and this new awareness of the body’s vulnerabil-
ity made them appreciate their body’s health even more. Elin said,
“One of my friends has gastric problems and another one has back
problems, so I feel fortunate not to have any of that. I think more
about that now than when I was younger.”
3.3.3.2. Perception of the body as integral to the self (1 man, 6 women).
Some participants, the majority women, described viewing their
bodies as integral to their self-identity. Emma said, “Every single
part of my body is me.” Other participants emphasized that eth-
nic features that were earlier a source of discontent were now a
source of pride as they were perceived to say something about the
participants’ origins.
3.3.3.3. Body acceptance (12 men, 12 women). The majority of the
participants accepted their bodies the way they were and did not
strive to change their appearance in any way. Jenny, for instance,
said, “I’m happy with my body. [. . .] I try to make the most of it.
I don’t put any effort into trying to change it. I have accepted that
this is the way I look.”
3.3.3.4. Body attunement and self-care (11 men, 8 women). Many
participants described that they were attuned to their bodies, lis-
tened to how their bodies signaled pain, stress, and anxiety, and
tried to adjust their activities according to these signals. Partic-
ipants took good care of their bodies via health-promoting and
stress-reducing activities (e.g., physical activity and relaxation).
Sebastian said, “You only live once so you need to take good care of
your body so it will last your whole life.”
3.3.3.5. Mentoring others to like their bodies (1 man, 6 women). Some
participants, in particular women, tried to mentor other people
(friends and family; e.g., the participants’ own children) to have
a positive body image, by encouraging them to love their bodies
and not to care too much about what other people think. Julia, for
instance, told us that her female friends often asked her about what
their male dates would think about their appearance and she would
answer, “It doesn’t matter what he thinks, what matters is what
you think. If you think you look good you look good, you don’t need
anyone else to tell you that.”
3.3.3.6. Filtering media images in a body-image-protective man-
ner (11 men, 10 women). Many participants expressed how they
interpreted media images of current appearance ideals in a body-
image-protective manner. This included being critical of the
appearance ideals, describing them as objectifying, disempower-
ing, retouched, unreal, non-functional, homogenous, unattainable,
and even tragic. These participants did not identify with the models
in the images and were not motivated to try to attain bodies like
theirs. Peter said, “Just because a body looks healthy on the outside
doesn’t mean it’s healthy on the inside. [. . .] and what good does
it do to me that they look fit?” Filtering media images in a body-
image-protective manner not only included filtering out negative
messages but also filtering in beneficial media. For example, a few
of the women were followers of body activists in social media.
3.3.3.7. Constantly practicing positive body image (1 man, 8 women).
Some participants, almost exclusively women, described how
maintaining a positive body image implies constant work, as they
59
were constantly exposed to societal messages asserting that they
should not be satisfied with their bodies. Sara said, “It requires con-
stant practice [not to care about negative comments]. If someone
says that I’m short I usually say that I’m pretty happy with being
short. I wouldn’t want to be taller. Because I’m a dancer and I would
feel clumsy.”
3.3.3.8. Feminist approach to body image (5 women). A third of the
female participants expressed having a strong feminist identity,
using feminist arguments to fight appearance concerns, and possi-
bly also engaging in various types of activism. Sara, who described
herself as a body activist, told us about an incident she had on an
internet dating site where a potential date asked her to send a full
figure photo. Sara, who felt objectified by this request, confronted
him: “The more I encounter these appearance prejudices, the more
I speak out.”
3.3.3.9. Appearance-enhancing investment (11 men, 4 women). Sev-
eral participants, mostly men, paid attention to the physical
appearance of their bodies and strove to change their bodily
appearance through strategies such as exercise. In contrast to the
participants aligned with the theme “Filtering media images in
a body-image-protective manner,” participants aligned with this
theme may describe feeling motivated by the appearance ideals
and viewing them as positive inspiration. Some participants, how-
ever, described that they were both critical of media images and
engaged in appearance-enhancing investment. Alexander said that
he exercised to be healthy, but “primarily in order to look good.
I’ve got my own little goals and an ideal body that I strive for.”
Karl described viewing appearance ideals as inspiring: “They are
an incentive for me to make a change.”
3.3.3.10. Perception of having a body that is close to the ideal (9 men,
3 women). Several participants, again mostly men, perceived they
have a body type not too far from current appearance ideals. When
Axel was asked about how he felt about appearance ideals in the
media, he said, “They are not a problem to me because I look more
like them than most people. It’s an appearance ideal that fits my
body.” Some of the men believed that they would probably be able
to attain an ideal body if they wished to put the time and effort into
doing so.
4. Discussion
This study is the first to examine the experiences of individuals
who have overcome having a negative body image in early adoles-
cence and have developed a positive body image on their way to
emerging adulthood. The study advances our understanding of dif-
ferent journeys to a positive body image and of the factors involved
in this notable body image trajectory, including the risk factors for
negative body image early in life, the factors that may serve as pos-
itive turning points, and the characteristics of positive body image
in emerging adulthood.
The graphs illustrating the participants’ different patterns of
body image development reveal that the journey from a negative
body image in early adolescence to a positive one in emerg-
ing adulthood can differ greatly. Some participants experienced
dramatic turns, both positive and negative, in their body image
development before finally stabilizing around a more positive body
image. Others experienced a steadier, gradual positive develop-
ment toward a positive body image. Regardless of the participants’
different developmental patterns, we found that most had devel-
oped a body image above the median of the large longitudinal
sample by age 18 years. This finding, that it took until the end
of adolescence for many individuals to make this developmental
step, is noteworthy. It adds a novel finding to existing research into
60 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
body image development in the critical phase of youth, suggest-
ing that body image development can take positive turns late in
youth development. However, the finding that none of the partic-
ipants had a very negative body image at age 18 years and that no
one was under the median at age 21 also indicates that this shift
towards a positive body image takes place around age 18 to 21, not
later. This could indicate that around the age of 18 years would be
an ideal time for effective body image interventions.
To understand the factors behind overcoming negative body
image, we thematically analyzed the participants’ stories. We iden-
tified three factors that contributed to the participants’ negative
body image in early adolescence, which partly coincide with pre-
vious findings on the risk factors for negative body image. The first
is that most participants perceived themselves to have a ‘deficient’
appearance in comparison with their peers in early adolescence.
They perceived themselves to be shorter, taller, chubbier, larger,
or thinner than their peers, or had other deficient appearance fea-
tures that troubled them. This finding supports previous research
demonstrating that individuals’ own negative perceptions of their
appearance in comparison with peers plays a major role in body
dissatisfaction (Lev-Ari, Baumgarten-Katz, & Zohar, 2014). Another
factor contributing to the participants’ negative body image in
early adolescence was the experience of negative peer influence.
The impact of peer appearance teasing (Menzel et al., 2010) and
bullying (Duarte, Pinto-Gouveia, & Stubbs, 2017; Lunde & Frisén,
2011) as well as experiences of peer appearance pressure (Helfert
& Warschburger, 2011) on adolescents’ body image is well estab-
lished and in line with theoretical frameworks, such as the tripartite
influence model (Thompson et al., 1999) emphasizing the influence
of peers on body image development. However, the fact that many
of the participants developed a positive body image despite being
victimized in early adolescence is noteworthy and deserves further
attention. It may be that the turning points identified here could
also inform bullying interventions in order to reduce the negative
impact of victimization on body image. For example, bullying inter-
ventions could guide adolescents into finding new social contexts
in which they feel accepted the way they are, or encourage adoles-
cents to develop effective coping strategies to improve body image,
as identified in this study.
The third and final factor contributing to the participants’ neg-
ative body image in early adolescence was perhaps our most novel
finding in this part, and concerned a feeling of discontent with life
in general and a lack of self-esteem extending to their body image.
Indeed, many researchers have connected negative body image to
low self-esteem (e.g., Davison & McCabe, 2006), but few theoretical
models point to ‘discontent with life in general’ as a risk factor for
negative body image. Depressive symptoms are often considered a
consequence of negative body image, but recent research into the
temporal association between the two factors has suggested that
this may not always be the case (Sharpe et al., 2017). For some early
adolescent boys (but not girls), depressive symptoms were the pre-
cursors of body dissatisfaction, indicating that how young people
experience life is mirrored in how they experience their bodies.
Previous research has also found experiences of life satisfaction to
be correlated with less body dissatisfaction and more body appre-
ciation in adolescents and young men and women (Góngora, 2014;
Swami & Ng, 2015).
We identified three factors that helped turn the participants’
negative body image into a positive one. A first turning point was
that the participants found a new social context, for example, new
friends or an encouraging romantic partner, providing them with a
sense of belonging and acceptance that helped them improve their
body image. The benefits of a new positive social context for body
image development are plausible, considering that the participants’
negative body image in early adolescence was often related to neg-
ative peer relations (e.g., appearance pressure, appearance teasing,
or bullying). This finding is consistent with both the acceptance
model, which proposes that social support and body acceptance
by others can promote positive body image (Andrew et al., 2016;
Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006), and the
developmental theory of embodiment (Piran & Teall, 2012; Piran,
2017), which emphasizes the importance of feeling included in
desired social contexts for the development of positive body image.
Although these models have been developed for girls’ and young
women’s body image experiences, the present findings suggest that
they can also be applicable to boys’ and young men’s experiences.
In line with these findings, there are already some body image
interventions that target and try to improve adolescents’ peer rela-
tions. However, the activities in these interventions tend to focus on
body image-related discussions of the acceptance of diversity and
on psychoeducational lessons about how peers can influence body
image through appearance-related conversations and appearance
comparisons (Bird, Halliwell, Diedrichs, & Harcourt, 2013; McCabe,
Connaughton, Tatangelo, Mellor, & Busija, 2017). For the present
participants, though, it was not the improvement of existing rela-
tions that enhanced their body image but the experience of finding
a new social context. Parents and teachers can play an important
role in encouraging adolescents to explore new social contexts to
find one in which they feel belonging and acceptance.
Another turning point in the participants’ positive body image
development was related to increased agency and empowerment.
The participants’ stories include a range of body-related expe-
riences of agency and empowerment—for example, excelling in
physical activities or sports, participating in acts of body activism,
or exploring and eventually finding a personal style of clothing and
grooming—and these experiences had helped the participants feel
more confident in their body. Indeed, previous research has demon-
strated that physical exercise generally improves body image,
although the effects have been found to be smaller for adolescents
than for older participants (Hausenblas & Fallon, 2006). Engaging
in physical exercise has been suggested to encourage people to
appreciate the functionality of their bodies, which is characteris-
tic of positive embodiment and body image (Holmqvist & Frisén,
2012; Mahlo & Tiggemann, 2016; Wood-Barcalow et al., 2010).
Exercise interventions targeting young adolescents have produced
positive results in terms of increased body esteem, but have failed
to maintain long-term effects (Burgess, Grogan, & Burwitz, 2006;
Duncan, Al-Nakeeb, & Nevill, 2009). For the present participants, it
was not only engaging in physical exercise that improved their body
image but also the sense of excelling in that exercise. This may be
one explanation of why exercise interventions do not successfully
promote positive body image in all adolescents. In addition, ado-
lescents may need to be given the choice of which physical activity
to engage in, to promote that they find one that they enjoy, since
enjoyable physical activity is key to positive embodiment (Piran &
Teall, 2012; Piran, 2017).
As indicated by the participants’ stories, however, various other
body-related experiences and acts other than physical activity can
promote young people’s agency and empowerment (e.g., singing,
sexual exploration, body activism, or exploration of personal style
of clothing and grooming), thereby also improving their body
image. In addition, some participants’ stories included the devel-
opment of a more general, non-body-related sense of agency and
empowerment that could involve succeeding at work or in stud-
ies. This led to greater feelings of competence and self-esteem,
which extended to their body image. Although the body-related
and the non-body-related experiences of agency and empower-
ment may differ greatly from each other, they both give a sense of
control over one’s life. Theoretically, these experiences are linked
to the concepts of physical and mental freedom, as identified in the
developmental theory of embodiment (Piran & Teall, 2012; Piran,
2017), as they contributed to the participants’ increased feelings
 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
of competence and empowerment, both physically and psycho-
logically. Intriguingly, this turning point of increased agency and
empowerment, as well as the turning point of finding a new social
context, both generally reflect the suggested core basic psycholog-
ical needs that all humans share: autonomy (perceiving oneself and
one’s behavior as an expression of the self), competence (a sense
of confidence and self-efficacy) and relatedness (connecting to and
caring of others, being cared for, and belongingness; Deci & Ryan,
2000). These connections can help provide a link between positive
body image and the field of psychology more broadly.
A third and final factor that served as a turning point in the
participants’ body image development was their own active use of
strategies to improve their body image. These strategies included
practicing body acceptance, avoiding or ignoring negative body-
related information, focusing on other things in life than physical
appearance, and realizing that pursuing appearance ideals means
having to sacrifice other things in life. It is clear that many of the par-
ticipants had successfully coped with and overcome their negative
body image by actively regulating their thoughts regarding their
bodies. We are not aware of any participant in this study who had
received clinical treatment to address their negative body image,
but it should be noted that some strategies used by the partici-
pants (e.g., practicing body acceptance) are strategies encouraged
in Acceptance and Commitment Therapy (ACT) for treating body
dissatisfaction as well as disordered eating (Fogelkvist, Parling,
Kjellin, & Gustafsson, 2016). A cognitive strategy mentioned almost
exclusively by the male participants was to realize that pursuing
the appearance ideal meant having to sacrifice other things in life.
As in the case story of Jakob, several of the young men had con-
cluded that having an ideal muscular body would entail giving up
some of life’s pleasures, such as certain foods and drinks, and being
forced to spend most of their time in the gym. For these reasons,
they deprioritized having an ideal body, which in turn helped them
improve their body image. One may wonder why this cognitive
strategy was not brought up by the female participants. One possi-
ble explanation is that engaging in one’s appearance and trying to
pursue the thin ideal are some of the most central feminine norms
that women need to adhere to in order to gain social acceptance
(Kling, Holmqvist Gattario, & Frisén, 2017). Women may therefore
find it more challenging than men to deprioritize this pursuit. Still,
realizing that pursuing the ideal means having to sacrifice other
things in life is likely to be a useful strategy for girls and women
too, although interventions implementing this approach on girls
will also need to challenge the associated feminine norms. Future
research could further examine how this ACT-related component
can be integrated into body image programs targeting both adoles-
cent boys and girls.
We identified several characteristics of the participants’ positive
body image in emerging adulthood. Some are consistent with previ-
ous findings from interviews with young women (Wood-Barcalow
et al., 2010) and adolescent girls and boys (Frisén & Holmqvist,
2010b; Holmqvist & Frisén, 2012) with a positive body image. These
include, for example, the features of body appreciation, body accep-
tance, body attunement and self-care, mentoring others to like their
bodies, and filtering media images in a body image-protective man-
ner. Interestingly, we did not specifically ask about these themes
in the interview and yet they map onto the definition of positive
body image proposed by Tylka and Wood-Barcalow (2015b), which
provides further evidence for the validity of their definition. This is
particularly noteworthy considering that this is the first study to
qualitatively explore positive body image in young men, suggest-
ing that several of the features of positive body image found among
women apply to men.
Other identified characteristics contribute novel findings to
the literature on what constitutes positive body image, adding to
the complexity of the construct. The young women in particular
61
described the necessity of constantly practicing body acceptance
in order to maintain positive body image, as they were unceasingly
exposed to various body-image threats, such as societal messages
asserting that they should not be satisfied with their bodies as they
are. Researchers have emphasized the idea of examining positive
body image not only as a stable trait but also as a state that can
fluctuate over time (Webb, Wood-Barcalow, & Tylka, 2015). Pre-
vious research has recognized this process of fluidity, for example
in that women with a positive body image sometimes have ‘bad
body image days’ but tend to recover to an overall positive body
image (Wood-Barcalow et al., 2010). Based on these findings, more
research is needed into when and why positive body image fluc-
tuates and that further explores young women’s constant practice
of maintaining a positive body image. In the case story of Sara, for
example, we learned that every time she felt bloated due to her
menstrual cycle, she reminded herself to appreciate it as a sign
that her body was functioning properly. This can be considered a
strategy of maintaining positive body image.
A few of the young women also described having a strong
feminist identity and used feminist arguments to address body
image concerns and media ideals. Previous experimental research
has demonstrated that exposure to a feminist perspective can
improve young women’s body image (Peterson, Tantleff-Dunn, &
Bedwell, 2006). A recent study of the role of social media messages
in young women’s self-objectification found that strong feminist
beliefs played an important protective role (Feltman & Szymanski,
2017). Yet, in focus group interviews, women themselves have
pointed out the that their feminist awareness and cognitions can-
not totally prevent them from experiencing body image concerns
(Kling et al., 2017; Rubin, Nemeroff, & Russo, 2004). In fact, some
women felt that their feminist cognitions sometimes led to more
distress, as now they did not only experience body image concerns,
but also felt guilty for continuing to engage in gender stereotypic
behavior although they ‘should know better’ (Kling et al., 2017;
Rubin et al., 2004). Feminist ideas, therefore, need to be cautiously
implemented into body image interventions, and preferably in
combination with ideas promoting a broader conceptualization of
beauty in order to de-emphasize the conflict that feminist women
may experience (Rubin et al., 2004) and compassion with body
image threats such as body image flexibility via ACT (Rogers et al.,
2018).
Positive body image characteristics that were more common
among the young men were making appearance-enhancing invest-
ments and perceiving one’s body as close to the ideal. These
appearance-oriented characteristics were somewhat unexpected
considering that positive body image has mostly been related to
non-appearance-related, embodying activities (Tiggemann, Coutts,
& Clark, 2014) and a functional, non-appearance-related view of
the body (Alleva, Martijn, Van Breukelen, Jansen, & Karos, 2015;
Frisén & Holmqvist, 2010b). The concept of “adaptive appearance
investment” has, however, been discussed as one important com-
ponent of positive body image, defined as “regularly engaging in
appearance-related self-care, such as grooming behaviors that pro-
tect an individual’s sense of style and personality—it is enhancing
one’s natural features via benign methods” (Tylka & Wood-
Barcalow, 2015b, p. 123). For the young men in the present study,
appearance-enhancing investments often concerned paying atten-
tion to the physical aspects of their bodies or engaging in physical
exercise to improve body shape. Although these behaviors could
possibly be included among adaptive appearance investments, it
can be difficult to distinguish between adaptive and maladap-
tive investments (Gattario & Lunde, 2018). However, according to
the present findings, appearance-enhancing investments can be
part of having a positive body image, at least among young men.
More research is needed to understand how appearance-enhancing
behaviors relate to positive body image.
62 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
The young men’s perception of having a body that resembles
the male body ideal is likely to be of importance to their positive
body image. With this perception, socially comparing themselves
to male body ideals does not necessarily generate negative feel-
ings, and instead, ideals can be viewed as positive inspiration, as
described by some of the men. It should be noted, however, that
although the men perceived themselves as being close to the ideal
does not necessarily mean that they were objectively close to the
ideal. Instead, they had ‘the feeling’ that the ideal was within reach.
This was also expressed by some of the participants who said that
they would probably be able to attain the ideal if they wished to
put the time and effort into doing so. Why did the women with
a positive body image not express this view? It may be that the
male body ideal is perceived as more attainable by the men than
the female body ideal is by the women. It may also be that it is more
accepted for men in general to verbally express that they resemble
the ideal as doing so can be seen as more coherent with the mascu-
line gender role featuring characteristics such as self-reliance and
dominance (Mahalik et al., 2003).
4.1. Limitations
It should be noted that the participants with a positive body
image in emerging adulthood were recruited for this study based
on their high body esteem at age 24 years as measured using BESAA.
One may argue that high scores on BESAA, which assesses feelings
about appearance and weight, do not adequately capture positive
body image according to recent conceptualizations, but rather the
lack of body dissatisfaction. However, to control for this limitation,
we assessed the participants’ body appreciation (a component of
positive body image) at the time of the interview. Our findings
indicated that, compared with mean values of body appreciation
previously obtained in community samples, the present partici-
pants had higher body appreciation, supporting the assumption
that the members of the sample had a positive body image at the
time of the interview. Several characteristics of the participants’
current positive body image were also in line with characteristics
identified in other studies of positive body image (Tylka & Wood-
Barcalow, 2015b). In addition, it should be noted that using BESAA
was helpful in identifying participants with a negative body image
in early adolescence, and it was also the general measure of body
image used in the longitudinal project from which the current sam-
ple was recruited. In fact, measures assessing specific components
of positive body image (e.g., body appreciation) had not yet been
developed when the longitudinal project started in the year 2000.
Future studies could further explore how development of body
esteem relate to development of body appreciation over time.
Another limitation associated with the recruitment of partic-
ipants concerns the fact that we were stricter in our criteria for
positive body image in emerging adulthood than in our criteria
for negative body image in early adolescence, considering that
we defined positive body image as having a BESAA score in the
fourth and highest quartile and negative body image as having a
BESAA score below the median. This was chosen as the best solution
because we wanted to ensure that the participants had a positive
body image in emerging adulthood while still obtaining a suffi-
ciently large sample.
Another limitation worth mentioning concerns the thematic
analyses and the fact that the themes identified in the analyses
depended on our interpretations of the participants’ stories. Espe-
cially regarding the turning points, these were not always described
as turning points by the participants, but were rather just parts of
the participants’ descriptions of their body-image journeys. Also, it
should be noted that many of the findings of this study are from
participants’ retrospective reflections on their body image journey.
It is possible that these reflections were affected by the fact that
the participants now inhabit a positive body image and look back
at their journey with “new eyes.” It is also possible that the par-
ticipants did not remember all the aspects that were important for
their positive body image development and therefore left out valu-
able information in the interviews. Future studies may benefit from
methods that aim at helping the participants remember their ado-
lescence, for example by asking them to bring in photographs of
themselves as adolescents or conducting several interviews over
multiple days, to allow participants time to reflect in between.
Finally, the present study is limited in that it has examined only
one pattern of body image development. It would be valuable for
future research to focus on other patterns of body image develop-
ment, for example, by assessing individuals who did not overcome
their negative body image in early adolescence, or individuals who
have had a stable positive body image from early adolescence and
onwards.
4.2. Conclusions
The present study examined the stories of individuals who over-
came a negative body image in early adolescence and developed a
positive body image on their way to emerging adulthood. Graphs
illustrating the participants’ body image development reveal a
range of patterns all leading to positive body image in emerg-
ing adulthood. However, most participants had already obtained a
positive body image by age 18 years. Thematic analyses of the par-
ticipants’ stories demonstrated that the factors contributing to their
negative body image in early adolescence were that they perceived
themselves as having a deficient appearance, had experiences of
negative peer influence, or experienced overall discontent and lack
of self-esteem that extended to their body image. Three factors
served as positive turning points in the participants’ body image
development: they found a new social context in which they felt
belonging and acceptance; they developed an increased sense of
agency and empowerment; or they used various cognitive strate-
gies to improve their body image. Several of the characteristics
that summarized the participants’ positive body image in emerg-
ing adulthood were in line with the findings of the few previous
qualitative studies of positive body image. However, the present
findings add evidence of new characteristics of positive body image,
which may differ between men and women. Namely, the women
in this study were more likely to think of positive body image as
needing constant work to maintain, and were also more likely to
have a feminist identity and address body image concerns by mar-
shalling feminist arguments. In contrast, the men were more likely
to engage in appearance-enhancing behaviors in order to improve
their body shape, and were more likely to perceive their body as
resembling the ideal. These gender differences are noteworthy con-
sidering that this is the first study to qualitatively examine young
men’s positive body image.
Overall, the present findings suggest that positive body image
development can be related to adolescents’ specific body expe-
riences, as well as to their life in general, general feelings of
acceptance, belonging, agency, and empowerment. Based on these
findings, we propose that body image interventions would bene-
fit from taking a more ecological approach (Piran & Mafrici, 2012).
This implies developing programs and actions that not only con-
sider matters directly related to the physical body but also work
with adolescents’ general sense of acceptance, belonging, agency,
and empowerment. Interventions could also target the relation
between adolescents’ bodies and their lives more broadly, for
example by encouraging them to reflect on how their body can
help them live a valued life. In addition, the present study gives
hope that body image development can take positive turns late in
adolescence.
 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
Appendix A
Interview topics and main questions:
(a) General idea of current body image:
• Could you please name the first three things that come to
mind when you think about your body? Why do you think
these specific things come to mind?
• Is there anything that you are particularly satis-
fied/dissatisfied with when it comes to your body?
Why?
(b) Influence of family and peers on body image when growing up:
• Could you tell me a little about the configuration of your fam-
ily/peer group when you were growing up?
• How did your family/peer group discuss aspects related to the
body?
• If your parents/peers commented on your body in any way,
positively or negatively, what did they say?
• If your parents did something to make you feel better about
your body, what did they do?
• What do you think your peers thought about how you looked
when you were younger?
• Do you think your parents/peers have influenced how you
think and feel about your body? How?
• If you had a romantic relationship with someone when grow-
ing up, do you think that person influenced how you think
and feel about your body?
(c) Reflections on their own picture:
• Could you please tell me what the picture features?
• Why did you choose this specific picture?
• What is it that you like about this picture?
• What kind of message does this picture send?
• What does this picture say about you as a person?
(d) Appearance ideals in the media:
(Participants are shown a set of typical images of appearance
ideals from the media).
• What do you think when you see these images?
• Are these examples of appearance ideals that you strive for?
Why/why not?
• Do you usually compare yourself to such images? Why/why
not?
• Do you feel down when you think about appearance ideals?
Why/why not?
• Do you have any specific strategies for coping with these
images?
(e) Reflections on their own body image journey:
(Participants are informed about their positive body image
development at this stage of the interview).
• Why do you think you have been able to overcome a negative
body image and develop a positive one?
• What role do you think your physical appearance has played
in your positive body image development?
• What advice would you give to other people who are dissat-
isfied with their bodies—what should they do to feel better
about themselves?
Appendix B. The Swedish BAS-2
Directions for participants: Var god ange om följande påståenden
stämmer in på dig aldrig, sällan, ibland, ofta eller alltid:
1 Jag respekterar min kropp
2 Jag trivs med min kropp
3 Jag tycker att min kropp har åtminstone några bra egenskaper
4 Jag har en positiv inställning till min kropp
63
5Jag är uppmärksam på min kropps behov
6Jag känner kärlek till min kropp
7Jag uppskattar min kropps olika och unika egenskaper
8Mitt beteende visar min positiva inställning till min kropp, till
exempel sträcker jag på mig och ler
9 Jag är bekväm i min kropp
10 Jag tycker att jag är vacker även om jag inte ser ut som attraktiva
människor (t ex modeller, skådespelare) på bilder i media
Appendix C
To further illustrate the participants’ different body image jour-
neys, the cases of Sara and Jakob are presented (for illustrated
trajectories of their BESAA development, see Figs. 1 and 2).
Sara
Sara’s BESAA scores in the longitudinal research project were
2.98 (10 years), 2.80 (13 years), 2.74 (16 years), 2.71 (18 years),
2.71 (21 years) and 3.40 (24 years). Sara’s BAS-2 score at the time
of the interview (age 26 years) was 4.00. In the interview, Sara
described being unhappy with several aspects of her body as an
early adolescent. She perceived herself to be shorter and skinnier
than her peers, and as she entered puberty she suffered from facial
acne, which she was very preoccupied with and strove to cover
with makeup. She was also annoyed that her skin was much fairer
than her peers’ skin and that she was unable to get a tan. From a
young age, Sara was a dancer and spent much of her time in the
dancing community. Appearance pressure was high in this context
and many of her peers suffered from eating disorders. Although Sara
did not develop an eating disorder, she clearly paid a lot of negative
attention to her physical appearance. Several turning points were
identified in Sara’s story. For example, she described how her first
boyfriend in ninth grade was a real “boost” to her body image: “I
had a lot of acne at the time and couldn’t for the world understand
why he still wanted to be with me, even though my face was full of
acne. But he wanted to, and we were so in love.” Sara also described
several experiences in relation to feelings of increased agency and
empowerment, and how these helped improve her body image. For
example, in terms of sexuality, she said that she was very inhibited
when she was younger, but that as she became older she learned to
be more attuned to her body, her needs and desires. Sara also expe-
rienced empowerment in relation to the physical appearance of her
body. She said that by having explored many alternative styles of
clothing and makeup, she realized that she did not need certain
clothing or makeup to be comfortable in her body, and that while
she still occasionally enjoyed dressing up and wearing makeup, she
preferred looking natural. Sara also said that she had worked hard
to finally dare to “take up space” in the world and to have a voice
in social contexts, by relying not on her physical appearance but on
her personality. She also described actively using various strategies
to improve her body image, such as trying to accept her body and
not engaging with appearance ideals. At the time of the interview,
Sara felt integrated with her body and had come to accept the acne
scars on her cheeks, her short height, and her fair skin, although
she admitted that she constantly strove to maintain acceptance of
these aspects of her body. She said that her body image varied over
the month with her menstrual cycle and that she needed to remind
herself every time she felt swollen, to appreciate it as a sign that
her body was functioning properly. Sara had a strong feminist iden-
tity, following feminist fat activist blogs. Her stance towards beauty
ideals in the media was critical, although she admitted a part of
her envied such beauty. In the future, she believed it would be an
important task to teach her children to be accepting of their own
appearance.
64 K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65
Jakob
Jakob’s BESAA scores in the longitudinal research project were
3.39 (10 years), 2.06 (13 years), 3.68 (16 years), 3.74 (18 years), 3.60
(21 years) and 3.49 (24 years). Jakob’s BAS-2r score at the time of the
interview (age 26 years) was 4.20. In the interview, Jakob said that
he was always much shorter than his peers and that, throughout
early adolescence, felt as though he was always treated differently
because of his height. He was pushed, beaten, and excluded from
the peer group. Although he was comforted by his mother, who
said that he was fine the way he was, it was hard for him to believe
her. To endure this period in his life, he tried to focus on other
things, such as doing well at school. The real turning point for Jakob,
however, was when he started to do weight training at the gym,
encouraged by a bet he had made with a peer. Jakob realized that
weight training was different from all the other sports he had tried
and disliked, and he enjoyed seeing the fast and increasing physical
results of his dedication in the gym. His new hobby gave him a new,
central role in the peer group: “When I started doing weight train-
ing, we had something in common. Something they wanted from
me. ‘You’re more muscular than me, could you give some advice?’
. . . All of a sudden, people started to listen to me . . . I was no longer
picked last in physical education. Sometimes they even picked me
first. When people start acknowledging you, that really affects you
from within.” Jakob’s increased confidence was also a springboard
for him to dare to get to know new people and find friends with
similar interests, not only related to weight training. At the time of
the interview, Jakob still enjoyed weight training but said he had a
soberer attitude to it and exercised because it was a natural part of
his lifestyle. He did not put too much time into it any longer because
“you need to have time to live a little as well.” Jakob came to accept
his height and appreciated that his body was flexible and adapt-
able and could do many different things. He said that his weight
training had helped him listen to his body and be more attuned to
what it could and could not do. When exposed to muscular media
images, his strategy was to think that the subject spent too much
time training and had probably abandoned more important things
along the way.
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