Why Do Women Feel Pressure to Be Thin? Study Examines Internalization of Appearance Ideals Across Cultures

Cleveland Clinic psychologist continues research on body image

Pressure to be thin

For women, the preference for thinness is pervasive across the Western world. But a new descriptive study found variability in how women in four different countries internalize messages about what their body should look like from the media, peers and family.

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“The bad news is that, across all of these cultures, the women reported high levels of internalizing the thin ideal,” says Leslie J. Heinberg, PhD, Vice Chair for Psychology in Cleveland Clinic’s Department of Psychiatry and Psychology. But it seems to be worse for women in the U.S.

Internalization of these pressures is a risk factor for body image dissatisfaction, eating disorders, depression and anxiety, she says.


Heinberg and a team of collaborators in four countries administered a 22-question Sociocultural Attitudes Toward Appearance Questionnaire to 2,275 university-aged women (mean age 20.08 years) in the United States (n=1,913), Italy (n=159), England (n=110) and Australia (n=93). The questionnaire assessed these women’s self-reported thin-ideal internalization and muscular-ideal internalization, as well as perceived appearance pressures from family, peers and media using a five-point Likert-type scale.

The results were published in the journal Eating and Weight Disorders.

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Their study was meant to build on existing knowledge about internalization of body-related messages. “One of the things that studies have demonstrated over the years is that women tend to have more internalization of these pressures than men,” Dr. Heinberg explains. “And women from Western cultures have more of this internalization as well.”

Cross-cultural differences

In the study, internalization scores were highest among women from the U.S. and Australia, and lowest among those living in Italy.

Women in the U.S. also generally reported the highest levels of the examined influencers (media, family and peers), while women from Italy generally reported lower levels. Peer pressure for thinness was highest among participants in the U.S.

Higher levels of internalization and risk factors might be in part due to differences in the lifestyles of these women in different countries, the authors suggest. “In European countries, they might go to their local college and live at home, whereas in the U.S., college students live in dorms and sororities, so peer influences are greater,” Dr. Heinberg says. “There also might be something about our culture that just puts more of an emphasis on appearance and thinness.”

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Across all four countries, participants indicated that the media are the top source of body image pressure for women, which the authors say demonstrates the ubiquity and power of media messages that promote the thin ideal. The emergence of Instagram, Snapchat and other social channels provide more opportunities for social comparison, Dr. Heinberg says.


These findings support the use of interventions specifically addressing thin-ideal internalization and media pressures, the authors write.

Examples of these interventions include media literacy programs that teach girls in their teenage or pre-teen years how to use critical thinking skills when they interpret messages from the media. Dr. Heinberg also points to public health-focused interventions, like France banning the use of models under a certain age or below a certain BMI, and requiring commercial photos that have been retouched to be labeled.

“We need to take the time to help youth be really smart consumers of media and give them some of the skills to have a critical eye,” she says.