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

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Body dissatisfaction, defined as a 'negative evaluation of one's ownbody' (1), is a major public health concern, with serious mental healthimplications . Negative feelings about one's own body have been saidto be "a critical component" of the majority of eating disorders (ED),where symptoms can include: having a distorted body image;excessive dieting and severe weight loss; a consequent pathologicalfear of regaining weight; as well as frequent episodes of "out ofcontrol" binge eating sometimes followed by inappropriate purgingsuch as self-induced vomiting or laxative use (2). It is claimed that6 / 9anorexia nervosa (AN) has the highest mortality rate of any otherpsychiatric disorder (3).Body Dysmorphic disorder (BDD), another psychiatric disorder whichis underpinned by an individual's body dissatisfaction, is defined as apreoccupation with an 'imagined' or 'perceived' flaw or defect inappearance, where the preoccupation causes clinically significantdistress or impairment in social, occupational, or other importantareas of functioning (4). The impact of this disorder is equally asdevastating as those with an ED, with it being reported that suicidalityis 45 times higher than that of the general population (5).Other health implications of body dissatisfaction include an increasedrisk of depression and anxiety, which in turn increases the risk ofengaging in more risk-taking behaviours such as self-harm,substance misuse and other risk-taking activities (6).To address this issue, Stice and colleagues have developed anevidence-base for dissonance-based interventions (DBI) for thealleviation of body dissatisfaction (7). The Body Project has evolvedover the last 16 years, and has produced a small number ofadaptations of the initial intervention scripts, resources and lessonsplans. One of the features of the project has been the use of 'peerleaders' to deliver the intervention, as well as an adaptation of thetraditional Body Project to be suitable for orthodox Jewish adolescentgirls.Following a systematic review conducted for my MSc studies (8) anda subsequent feasibility study, I concluded that the needs of ethnicminorities have not been extensively researched when it came todelivering body image interventions, such that resources targetingspecific issues these groups may face are lacking.Feasibility StudyIn January-March 2018, I conducted a small scale feasibility study withthe charity Rethink Mental Illness. A generic school-based wellbeingintervention responded to the demand for a body image and eatingdisorder specific intervention that was suitable for Black, Asian andMinority Ethnic (BAME) girls. Following a focus group (n=10),emerging themes such as the impact of institutional racism, familialattitudes towards eating and the impact of fasting religious practiceswere raised as issues which weren't addressed in typical body imageinterventions. This led to us co-designing content based on theprinciples of evidence-based content such as appearance ideals, butthrough a cultural lens.As a result, culturally inclusive workshops addressing body image andeating behaviours were co-produced and piloted in two London-basedschools. Results showed that post-intervention, 90% of participants(n=40) felt able to use techniques to manage their body imagebetter and stated that they knew where to seek help should theyneed to. The study also showed that using a co-production modelreaps mutual benefits for both the participants and the experts-byexperience involved in the co-design and co-delivery process.Although this feasibility study is not yet published, it demonstrates afoundation to this project proposal and provides rationale to theproposed study.