Body image issues in adolescence linked to depression in adulthood

Teenagers who are unhappy with their bodies are more likely to develop symptoms of eating disorders and depression in early adulthood, according to a new study led by University College London (UCL) researchers.

The research, believed to be the first of its kind, followed more than 2,000 twins born in England and Wales. It found that higher body dissatisfaction at age 16 predicted greater symptoms of eating disorders and depression well into the twenties, even after taking into account family background and genetics.

Researchers say the findings strengthen evidence that negative body image is not just a reflection of poor mental health but that it can also contribute to it.

The study, published in The Lancet Psychiatry and funded by Wellcome, used data from the Twins Early Development Study (TEDS), a long-running birth cohort tracking the health and wellbeing of twins born between 1994 and 1996.

By comparing identical (monozygotic) twins (who share 100% of their DNA) with non-identical (dizygotic) twins (who share roughly half), the researchers were able to analyse the roles of shared genetics and environmental influences.

Lead author Dr Ilaria Costantini, from UCL’s Division of Psychiatry, said: “In the last 20 years there has been a concerning increase in depression and eating disorders among young people, so it’s important to find out what is driving this increase in order to develop ways to prevent mental health problems from occurring.”

Girls more strongly affected

The study participants were asked at age 16 about body image concerns, including feeling ‘fat’, fearing weight gain and judging themselves by their weight or body shape. Participants were also surveyed at age 21 about eating disorder symptoms, and at both 21 and 26 about depressive symptoms and body mass index (BMI).

The researchers found that higher levels of body dissatisfaction at age 16 were linked to significantly higher eating disorder and depressive symptom scores in early adulthood. Their twin study design enabled them to factor out the effects of shared genes and other environmental factors shared by the twins such as the same family, neighbourhood and school, to determine that body image concerns in adolescence do appear to cause an increase in later mental health issues.

While both boys and girls showed links between body dissatisfaction and later mental health problems, the associations were stronger in girls.

Dr Costantini said this could reflect the greater cultural and social pressures placed on young women to meet unrealistic appearance standards, commenting: “In Western societies we typically presume that young women are under greater pressure than young men to look a certain way, especially in relation to thinness, and our findings do suggest that these pressures may translate into stronger long-term mental health effects for girls.

“However, it is important to recognise that this may partly reflect the limited way in which body dissatisfaction was measured in this cohort. The items focused mainly on weight and shape, which tend to be more salient concerns for girls. If we had captured body dissatisfaction in a broader way — for example by including muscularity, height, skin, or other appearance-related concerns — our findings for boys might have been different.”

The association between body dissatisfaction and later BMI was weaker in identical twins than non-identical twins, suggesting that shared genetics may explain much of the link between feeling unhappy with one’s body and actual changes in weight.

Mental health and public health implications

Senior author Professor Francesca Solmi (UCL Division of Psychiatry) said the findings underline the importance of tackling body dissatisfaction as part of wider public health strategies: “It is vital that body dissatisfaction is tackled head-on during the teenage years across multiple settings, including in the school system, government healthcare strategies and in the wider culture.”

The researchers say effective prevention will require broad, coordinated action. This could include regulating harmful social media content or developing school and public health campaigns to promote body acceptance, particularly to ensure that obesity prevention efforts avoid reinforcing negative body image or weight stigma.

Professor Solmi added: “We need to create environments that value diversity in appearance and avoid sending harmful messages about weight or beauty ideals. That means working with families, schools, and the media to ensure we are not promoting unhealthy beauty and weight standards.”

Umairah Malik, Clinical Manager of Beat, the UK's eating disorder charity, commented: “This study is an important step towards furthering our understanding of eating disorders and the different factors that increase a person’s risk of developing one. The more we know about these devastating mental illnesses, the better equipped we are to prevent them.  

“The study clarifies that body dissatisfaction, while having a genetic component, is also shaped by environmental factors, which are likely to have contributed to its increased prevalence in recent years. It also adds particular value in understanding the role of body dissatisfaction in both mental and physical health.

“It’s vital that we address societal stigma around weight as it can contribute to body image concerns. These findings reinforce the urgent need for preventative approaches. We strongly support its call for sustained prevention efforts across different environments including in schools, public health messaging and in the media.” 

A mix of genetics and environment

The study found that both genetic and environmental factors play a role in shaping body image and its link to mental health. Roughly half of the variation in body dissatisfaction was explained by genetic influences. However, non-shared environmental factors – unique experiences that differ even between twins – also contributed.

This means that while some people may be genetically predisposed to body image concerns, life experiences such as peer pressure, bullying, or exposure to images conveying unrealistic beauty standard images (such as social media and celebrity culture) can still make a major difference.

A previous study led by Professor Solmi found that body dissatisfaction at age 11 predicted an increased risk of depression at age 14, suggesting that these patterns can start at a very young age.*

* UCL News, 2023: Body dissatisfaction linked with depression risk in children