Psychology, Marketing and Eating Disorders: Integrating the Evidence From the Literature

ABSTRACT - This paper’s contribution comes in the form of integrating the psychological and marketing literature relating to eating disorders (such as anorexia nervosa and bulimia). The paper argues that there is tentative evidence pointing to a connection between the use of thin models in advertising and the incidence of eating disorders amongst young women. Alternative executional approaches are offered, as well as making recommendations for future research in this area.

Citation:

Gerard P. Prendergast (1998) ,"Psychology, Marketing and Eating Disorders: Integrating the Evidence From the Literature", in AP - Asia Pacific Advances in Consumer Research Volume 3, eds. Kineta Hung and Kent B. Monroe, Provo, UT : Association for Consumer Research, Pages: 120-125.

Asia Pacific Advances in Consumer Research Volume 3, 1998      Pages 120-125

PSYCHOLOGY, MARKETING AND EATING DISORDERS: INTEGRATING THE EVIDENCE FROM THE LITERATURE

Gerard P. Prendergast, Hong Kong Baptist University, Hong Kong

ABSTRACT -

This paper’s contribution comes in the form of integrating the psychological and marketing literature relating to eating disorders (such as anorexia nervosa and bulimia). The paper argues that there is tentative evidence pointing to a connection between the use of thin models in advertising and the incidence of eating disorders amongst young women. Alternative executional approaches are offered, as well as making recommendations for future research in this area.

BACKGROUND

The lack of ethics in advertising is a widely held debate which is gaining momentum. A familiar criticism of advertising is that it debases the tastes of the public by presenting irritating and aesthetically unpleasant displays. Others say that advertising is wasteful because it does not lead to an improvement in the product itself. This view is not new. During the late 1950s John Galbraith and others argued that advertising is manipulative because it is intended to arouse in the consumer a psychological desire for the product without the consumer’s knowledge and without the consumer being able to rationally weigh whether the product is in his or her best interests, or attempt to make consumers associate unreal sexual or social fulfillment with a product. In some cases advertising is even accused of encouraging consumrs to engage in unhealthy activities such as cigarette smoking and the pursuit of an "ideal" slim body which may be portrayed in advertising as being desirable.

Advertising often presents an attractive female body (usually thin) to the viewer in the process of selling a product. Most of these advertisements extol beauty, vitality, sexuality, and, slimness. Typically two or more of these elements are linked. For example, if a model is slim, she is also portrayed as being beautiful and sexually desirable. The problem, however, is that in reality few females actually meet the standard of slimness which is portrayed in advertising as being desirable. Body image distortions may occur, especially amongst young females, because of the psychological pressure that results from the contrast between the ideal body image and the individuals objective body shape. Individuals who experience this distortion of body image may begin dieting and exercising in excess. In a few sad cases, the pathological pursuit of the ideal body leads to eating disorders such as anorexia nervosa and bulimia, or even death. Sadly, in recent times there has been an increase in the number of women suffering from eating disorders in the western world.

Little research has been done concerning the relationship between advertising and eating disorders. Perhaps this is because market researchers see the domain of eating disorders as belonging more to the abnormal psychologists. Related to this, the psychological work in the area tends to ignore the marketing work in the. In addition, while researchers are quick to criticize the use of thin models in advertising, few alternative executional approaches have been offered.

Based on the previously mentioned shortcomings, this paper has three objectives. First, to synthesize the evidence (from both the psychological and marketing literature) which shows whether or not there is a relationship between the portrayal of thin models in advertising and the presence of eating disorders amongst young women. Second, to suggest alternative ways in which advertisers might meet their objectives. Third, to make recommendations for further research.

WHAT IS AN EATING DISORDER?

For the purpose of clarification, a distinction needs to be made between the two eating disorders anorexia nervosa and bulimia. An Anorectic refers to persons who have a constant obsession with food and weight. They restrict their diet and do not exhibit symptoms of bulimia (Killian, 1994). Symptoms associated with anorexia nervosa include a weight loss of at least 15% below what is deemed "normal" for age and height, an intense fear of gaining weight/perception of being fat, and the absence of at least three consecutive menstrual cycles (American Psychiatric Association, 1987). A Bulimic individual is characterized as someone who consumes 3 to 27 times their recommended daily food allowance (Abraham and Beaumont, 1982). Symptoms associated with bulimia include recurrent binge eating; regular engagement in self-induced vomiting, diet pills, laxatives or diuretics, or excessive exercise; persistent concern with body weight and shape (American Psychiatric Association, 1987). Myers and Biocca (1992) quoted a Nielsen survey suggesting that 45% of all US households have someone dieting. Of all women aged 24-54, 56% are dieting. However, there is a marked difference between healthy and unhealthy dieting. Weight loss, in an attempt to achieve the ideal body image, is more than inches and pounds to the woman with an eating disorderBit becomes a way of life. Starvation, binge eating, and purging become intensely emotional experiences.

It is difficult to give an accurate measure of the number of people suffering from eating disorders. Although approximately 95% of anorectics and 90% of bulimics are women, estimates of the prevalence rates for the two disorders among females vary. Estimates for anorexia range from less than 1% to 3% of females (Muuss,1985). The onset of anorexia and bulimia, typically during adolescence or early childhood, results in prevalence rates in this age group being significantly higher than in the general population (Killian, 1994). The prevalence of bulimia is more difficult to determine because bulimics, unlike anoretics, typically do not exhibit weight loss and, like anorectics, are resistant to discuss their problem. However, estimates range from 0.9% to 13% of females (Fairburn and Beglin, 1990; Halmi et al, 1981; Schotte and Stunkard, 1987). Sadly, the incidence of anorexia cases in the western world has shown signs of increasing over the past two or three decades (Killian, 1994; Crisp et al, 1976; Garner et al, 1980; Margo, 1985).

PSYCHOLOGY’S EXPLANATION OF EATING DISORDERS

First, it seems reasonably clear that genes for self-starvation or binge eating do not exist (Vitousek and Manke, 1994). Therefore, there must be some other explanation. Most of the psychological literature tends to lay responsibility for eating disorders on personality factors, demographic factors, family factors, and cultural factors. Early investigators concurred that the predominant personality type, combining features of inhibition, obsessionality, and compliance, was evident in 69% (Dally, 1969) to 87% (Norris, 1979) of the patients examined. These perfectionist, compliant, and isolated girls seem to experience considerable turmoil during adolescence, which places a premium on the very qualities of spontaneity, independence, and social facility that they lack (Vitousek and Manke, 1994). Casper (1982) commented that

when in such children self-induced dieting meets with success and affords them an occasion to feel competent through their own action, they seize this opportunity to direct their weight with unusual determination in an erroneous belief that thereby they can win control over themselves and their lives (p. 437)

In addition to personality variables, social class has been found to be associated consistently with the incidence of eating disorders (Askevold, 1982; Fairburn and Cooper, 1984). In particular, a disproportionate number of sufferers tend to be middle and upper-class women. Other factors, such as race, order of birth, incidence of broken homes, and parental age at time of patient’s birth are not found to be associated with the incidence of eating disorders.

Family factors also offer some explanation. Eating disordered families tend to demonstrate more stability and less openness in discussing disagreements between parents and children (Kog and Vandereycken, 1989; Waller, Calam and Slade, 1989; Humphrey, 1986). Bulik (1987) found a higher incidence of depression and alcoholism in the relatives of women suffering from eating disorders. Families of women with eating disorders tend to be characterized by a high level of enmeshment i.e. blurred generational boundaries and a leadership vacuum (Minuchin et al, 1978; Stierlin and Weber, 1989).

It has been hypothesized that the incidence of eating disorders might by connected with western society’s preoccupation with food, dieting, and being attractive (Garner, Garfinkel and Schwartz, 1980; Lakoff and Scherr, 1984; Muuss, 1985; Schwartz and Barrett, 1988). In particular, the portrayal of thin models in advertising. Eating disorders arise due to an individual’s distorted perception of their own body image. A body image is a mental construction, not an objective evaluation (Bell, 1991). There is much evidence to suggest that body images can deviate substantially from the person’s objective physical characteristicsBthis is at the heart of the eating disorder problem. Furthermore, it seems that the body image is unstable and responsive to social cues, such as advertising. This is often referred to as the "elastic body image".

According to Bell 1991), in the construction of her present body image a young woman will draw upon four reference models 1) socially represented ideal body 2) her internalized ideal body 3) her present body image, and 4) her objective body shape. Objective body shape represents a reality limitation on one’s perceived body image, however, it is never seen objectively but always through the perceived veil of one’s body image.

Individuals internalize a social model of the ideal body image. The socially represented ideal body is absorbed from cultural representations of ideals of physical beauty. In western culture, the ideal may be represented most forcefully through the mass media. It is in this situation that marketers need to understand whether or not the portrayal of thin models in advertising causes or accentuates eating disorders amongst young women. According to Killian (1994)

the western standard for beauty and attractiveness is thinness, as can be seen in media depictions........anorexia and bulimia facilitate women’s attempts to meet society’s standard of attractiveness.

Pumariega (1986) reinforces this view by suggesting that greater adherence to the norms of western culture (as reflected in the mass media) might increase one’s risk of developing an eating disorder.

DOES ADVERTISING USE THIN MODELS?

The preceding arguments suggest that some women model themselves on the thin models used in advertising. A consumer behaviorist would refer to this as vicarious learning (also called modeling, observational learning or imitative learning). With vicarious learning, people change their behavior because they observe the behavior of others and its consequences. People imitate others when they see that it leads to positive consequences. For instance, an advertisement may show a thin model being dated by a handsome, well-dressed man. Thus the modeled behavior (a thin figure) is shown as having reinforcing consequences (attention from men).

The main reason why advertisers usually use thin models is because they believe it is effective to sell a product using a physically attractive model or product endorser. Physically attractive sources are seen as being more persuasive (Baker and Churchill, 1977). And, in general, most people in society see thin people as being more attractive than fat people. Advertisers want their advertising to be effective, and it therefore makes sense that they use product endorsers who are able to positively influence consumers’ attitudes towards the advertisement and the advertised brand.

Before blaming advertising for an increase in the incidence of eating disorders, there must first be evidence that thin models are indeed used. Statistics aside, general observation would suggest that the ideal body shape for women is becoming thinner. There are a number of trends which support this assertion. For instance, there is a linear phase in the fashion cycle of curvaceousness (Silverstein et al, 1986). These days, the Cher image is seemingly more acceptable than the Marolyn Munro image. There are also health concerns regarding obesity (Polivy and Garfinkle, 1988)Breflected in the large number of new "non-fat" product lines. In addition the roles of women in society are changing, with women becoming more visible. This visibility places more pressure on women to maintain an "appropriate" public appearance.

The simple fact that a culture might prefer a thin figure does not necessarily mean that advertising is portraying thin figures. More evidence is needed for the latter. Further to this, Garner et al (1980) studied the ideal feminine image as presented by Playboy Magazine and the Miss America Pageant from 1959-1978. The mean weights of women in these groups were significantly less than the mean weigts of the general public. In addition, during the 20-year period mean weights for centerfolds and contestants declined, while mean weights for the general population have actually increased by several pounds.

In another content analysis, Silverstein et al (1986) did a study of the curvaceousness of female advertising models in Vogue and Ladies’ House Journal. Their results showed that after 1949 there was a move towards a more linear body shape.

Perhaps the most substantial research conducted in the area of the "thinning" of the female body shape in media was conducted by Fay and Price (1994). They conducted a content analysis of popular New Zealand magazines covering the period 1958-1988. By taking a number of measures of females appearing in advertising, they arrived at the conclusion that the body shape of contemporary models in advertising is less curvaceous and approximately 8kg lighter than the shape of the 1950s, with reductions in the size of shoulders, chest and hips. For a women of average height (1.65m) to meet the body shape of contemporary models would require a weight of approximately 42kg in contrast to the median weight of 60.5kg.

In summary, it is reasonable to conclude from these studies that the emphasis, especially in recent times, has been on the use of thin models. In addition, when compared to men, women receive far more media messages emphasizing the importance of being thin (Silverstein et al, 1986). In fact, one study has noted that paralleling the rise in eating disorders was been an increase in the number of articles and advertisements promoting weight-loss diets in women’s magazines (Wiseman et al, 1992).

DOES THE USE OF THIN MODELS IN ADVERTISING LEAD TO A FEAR OF FAT?

Advertising has been vilified for upholdingBperhaps even creatingBthe emancipated standard of beauty by which girls are taught from childhood to judge the worth of their own body. However, evidence of the use of thin models in advertising is not sufficient in itself to lay responsibility for eating disorders with the marketers. The crucial issue is whether or not a connection exists between the use of thin models in advertising, and the occurrence of eating disorders amongst young women. One grouping of research did not look at thin models in an advertising context, it simply looked at how women felt after being exposed to images of thin models. For instance a study by Irving (1990) revealed women to slides of thin, average and heavy models. Results showed that exposure to thin models resulted in lower self-esteem and decreased weight satisfaction. Similarly, an experiment that exposed women to pictures of models from women’s magazines found that exposure to thin models, rather than average-sized models or control photographs with no women, produced increased depression, stress, guilt, shame, insecurity, and body dissatisfaction (Stice and Shaw, in press).

Other research has looked at the use of thin models in advertising specifically. Peterson (1987) asked his female survey respondents "do you believe that the advertisements you see and hear create strong images of the desirability to be thin, thereby inducing you to keep weight down?". 91% of those with eating disorders answered "yes", compared with only 54% of those without eating disorders. This would suggest that, at the very least, advertising accentuates the eating disorder problem amongst existing suffers.

Research by Myers and Biocca (1992) revealed that watching even 30 minutes of television programming and advertising can alter a woman’s perception of the shape of her body. However, it is not known how long it takes for this perception to once again alter. As was mentioned earlier, the body image is unstable and responsive to social cues.

Martin and Kennedy (1993) suggest that using thin models in advertising may act as a catalyst to bring on eating disorders caused by more deep-seated problems. They saythat the tendency of female preadolescents and adolescents to compare themselves to the models in advertisements increases with age, and this tendency is greater for those with lower self-perceptions of physical attractiveness. In this sense, the use of thin models in advertising is seen as a catalyst for, not a cause of, eating disorders amongst young women.

Stephens et al (1994) tend to agree with Martin and KennedyBwhen exposed to advertisements with thin models, womens’ dissatisfaction with body shape and their overall attractiveness increases. This dissatisfaction may result in the woman trying to achieve the same body shape as the model in the advertisement. In order to achieve a nearly impossible thinness, chronic dieting results. And chronic dieting in the presence of low self-esteem, adolescent turmoil, and a family history of affective disorders is especially likely to lead to anorexia or bulimia nervosa.

The work of Stice et al (1994) was the most comprehensive attempt to examine the relationship between media exposure and eating disorders. They collected data from 238 undergraduate students. The students were first asked, on a scale, to indicate their level of media exposure. They were then asked to complete separate scales relating to ideal-body stereotype internalization, body dissatisfaction, and eating disorder symptomology.

This became the first study to show a direct linkage between media exposure and eating disorder symptoms, thus supporting Stice et al’s assertion that internalization of sociocultural pressures mediate the adverse effects of the thin ideal.

To conclude, while there is no evidence of a causal link between the amount of thin models used in advertising and cases of anorexia nervosa, at the very least it can be said that advertisements legitimize and confirm societal pressure to be thin. To prove a causal link would be extremely difficult, if not impossible. Any effect of media exposure on body dissatisfaction is mediated through internalization of the thin ideal, and therefore no direct path can be predicted from media exposure to body dissatisfaction. But it is known from longitudinal research that there is a strong relation between media use and gender-role endorsement (Morgan, 1982). Thus if media can influence an individual’s perception of his or her gender role, it can certainly influence an individuals perception of his or her body image.

Figure 1 illustrates what this paper argues are the main forces leading to the development of eating disorder symptoms. Based on this figure, the use of thin models in advertising is one of a number of complex variables that can lead to very sad consequences.

ALTERNATIVE CREATIVE APPROACHES FOR THE ADVERTISERS

The limited evidence to date, especially the work of Stice et al (1994), tentatively points to an association between the use of thin models in advertising and eating disorders. This evidence is not enough to issue an order to advertisers to change their advertising execution. Until more evidence is gathered, however, it may be socially wise for advertisers to at least begin to consider alternative approaches to advertising execution. Three alternatives are offered:

1.  Myers and Biocca (1992) suggest that there is a classification of advertisements as body-image-oriented and neutral-image oriented. In a body image program, a significant part of the advertisement has explicit concentration on the representations of the ideal body. On the contrary, a neutral image program may contain attractive actors but concentration on their bodies is not the major focus, so that the model becomes the background rather than thecentral figure. Simply, advertisers can use a more neutral image by giving less attention to hips, thighs and abdomen, which are areas where size is most overestimated by anorexics and young women in general. The advertisement could instead focus on parts of the body only, such as the hands, or face. These parts are not particularly sensitive to women who are or may suffer from eating disorders. Alternatively, more attention could be paid to the product being advertised.

2.  If the focus has to be on the model, is it really necessary to have one which is excessively thin? In the words of Fay and Price (1994), "would the advertisement be any less effective if the models were five kilograms heavier?". In addition, advertisers should be very careful in the adjustment effects of camera angle and pose of the model, since this can produce a set of dimensions which is very different from the real body shape of the model. The model’s make-up is also relevant, since certain shades can produce an exaggerated gaunt look.

3.  Physical attractiveness is not the only factor which makes a message source more persuasive. Evidence suggests that sources which are likable (Kahle and Homer, 1985), hold celebrity status (Petty, Cacioppo, and Schumann, 1983) or are similar to the target audience (Woodside and Davenport, 1974) can also be very persuasive.

FIGURE 1

SUGGESTED MODEL OF EATING DISORDERS

FURTHER RESEARCH NEEDS

The main problem with past research in this area is that it tends to separate marketing from psychology, when in fact the two areas need to be combined. In a practical sense, there is a need for joint research projects between marketers and psychologists. These projects would recognize that the influences on eating disorders come from both the psychological and marketing domains. Specific areas of research needed are:

B  more compelling evidence is needed which demonstrates the effect of media exposure on endorsement of the thin ideal. Also, although a large number of women are exposed to media images of thin, only a small number develop eating disorders. Research which identifies these moderating effects of the media is very much needed. However, it must be recognized that it is very difficult to isolate the effects on behavior and attitudes of media advertising from other marketing variables such as distribution, price, point of sale promotion, and public relations, let alone from external variables such as editorial or programs in the media, family and peer-pressure groups, and personal characteristics such as age, income, education, family composition, and indeed heredity. To be convincing a research design needs to acknowledge their existence and take account of or eliminate such other influences which might have an at least equal effect.

B  more work is required to examine the changing body shape of women in advertising. In recent times the popular press suggests that some advertisers may be moving away from using thin models, but further research, probably in the form of a content analysis of popular magazines, is needed to support this suggestion.

B  more research is needed into how eating disorder and media issues relate to Asian culture. It is a fact that in many Asian countries, the average woman is smaller than the average western woman. Does the fact that Asian women realize they are smaller have a moderating effect on those variables influencing the development of eating disorder symptoms?

B  eating disorders not only cover individuals who are excessively thin, but, in the case of obese individuals, eating disorders may also refer to those who are excessively fat. Newspaper reports suggestthat in the US and UK something like one in three of all adults are overweight. The marketing and advertising of unsuitable foodstuffs has been out forward as a possible cause. Research, therefore, may also like to consider how advertising encourages the obese to become fatter.

While most of the psychological research relating to eating disorders has tended to adopt an experimental approach, the marketing research in the area tends to use survey approaches. It may be time for marketing, in its examination of the impact of media on eating disorders, to adopt more experimental designs.

CONCLUSION

Evidence from the research leads to the tentative conclusion that, at the very least, the use of thin models in advertising is partly to blame for the increasing incidence of eating disorders amongst young females in western countries. A tentative conclusion, however, is no basis for recommending that a law be developed against the use of thin models. In this sense, therefore, marketers need to be self-regulating and rely on their ethical standards. An ethical standard, however, is not absolute. It is not like the standard of the law which states what is right and wrong. Ethical standards are on a continuum.

Advertisers need to recognize the possibility that thin models do more than simply influence sales. It is normal for women to compare themselves to thin models, since women place a higher priority on personal weight than men. Advertising provides social cues in the construction of individual’s self. These social cues are very important not because they determine exactly what the audience perceives itself to be, but because social cues influence which attribute groups will be most important in that individual’s self model.

Advertisers, not psychologists, are responsible for the consequences of their advertisementsB whether these consequences are commercial or social. Advertisements should not just be pretested for recall and attitude change, but they must also be pretested for potentially negative effects on society.

Regardless of the efforts which marketers might make to reduce the effect of advertising on eating disorders, it is not totally the marketers responsibility. While advertising influences society, society also influences advertising. Further to this, society, in some cases, also recognizes and endorses thinnessBso society needs to exercise social responsibility too.

Audiences should take a part in social responsibility and advertisement selection. A clever and knowledgeable audience may be capable of correctly interpreting an advertisement that may be misleading to a less knowledgeable or vulnerable female groupBwhich is less capable of understanding a normal, fit and healthy standard.

The area of advertising and eating disorders is one where a great deal more research needs to be conducted, despite the fact that such research would present great methodological difficulties. In the meantime, until more conclusive evidence is found, it is hoped that marketers will exercise caution in the use of thin models in advertising. Use of thin models is not the only route for marketers to achieve their advertising objectives. There are other executional alternatives which may be equally effective, and have the potential for causing less damage to society.

Commercial and psychiatric aspects aside, eating disorders represent an incredibly sad illness which strike otherwise normal women at a very tender age. The situation is further saddened by the recognition that the illness is based not on fact, but on a misperception of reality. For the victims, it is intensely emotional, and sometimes fatal. For the families of the victims, the situation seems not only bizarre, but intolerable.

Use of alternative executional approaches should be encouraged. Such action may not only reduce the numer of women finding themselves with eating disorders but, from a more practical commercial point of view, it would quieten those individuals who, although may not be suffering from an eating disorder themselves, consistently look for ways to question the ethics of advertising.

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