Publications from the Centre for Appearance Research (CAR)

Introduction Disordered eating has become increasingly prevalent among children and adolescents, with weight talk identified as a potential contributing factor. Method This meta-analysis examined the strength and nature of this relationship using a three-level model across 460 effect sizes and examined potential moderators related to the characteristics of weight talk, types of disordered eating, and characteristics of sample. Results Results indicated a small but significant positive association between weight talk and disordered eating (r = 0.27). Moderation analyses revealed that characteristics of weight talk and types of disordered eating significantly influenced this relationship. In particular, the strongest associations were observed when weight talk was negative, targeted both the listener and oneself, originated from the self, and involved mixed forms of weight talk (i.e., comments, teasing, and encouragement to lose weight). The association was most pronounced for variables related to anorexia and bulimia. In contrast, participant characteristics such as age, gender, ethnicity, and country were not significant moderators. However, the sample was predominantly female and White, limiting the generalisability of the findings. Conclusion These findings highlight the importance of addressing weight talk in prevention and intervention efforts to reduce disordered eating among children and adolescents.

Sport and exercise environments have historically perpetuated gender stereotypes and reinforced unequal expectations about women’s bodies and abilities (Senne, 2016). The increasing emphasis on body ideals in sport and fitness create additional pressures (Matheson, Schneider, Tinoco, Silva-Breen, et al., 2023). Moreover, many physical activity spaces are saturated with weight bias, making it more difficult for everyone (irrespective of their body size and body image) to participate in, and benefit from, these spaces (Zuest et al., 2022). This is reflected in the limited impact of public health efforts to promote physical activity among girls and women. Physical activity rates remain disproportionately lower in these groups, and women’s participation has not increased over the past decade (Guthold et al., 2018; Mello et al., 2023; Strain et al., 2024). The main objective of this thesis is to demonstrate how my research shifts the needle forward in the use of co-creation to inform effective interventions across diverse physical activity settings. My ultimate aim is to improve girls’ and women’s body image, promote weight-inclusive environments, and reduce barriers to sports participation. The included publications draw on Community-Based Participatory Research principles (Collins et al., 2018; Wallerstein & Duran, 2010), positive body image theory (Tylka & Wood-Barcalow, 2015), the Health At Every Size® framework, and Embodiment Theory (Piran & Teall, 2013), to support the central argument that partner involvement is necessary to develop inclusive and affirming physical activity settings that foster meaningful exercise and positive body image among girls and women. Although many interventions aim to address the link between body image and physical activity, theoretical and methodological flaws have hindered their effectiveness (Matheson, Schneider, Gentili, et al., 2023). Further, most studies did not consult with partners, which has implications for feasibility, acceptability, scalability, and efficacy (Matheson, Schneider, Gentili, et al., 2023; Schneider, Tinoco, Scott, et al., 2024). This thesis addresses this and other research gaps by focusing on understudied populations in the field of body image and weight bias, such as fitness professionals and coaches; including populations at high risk of developing body image concerns, such as girls and women in adolescence and midlife; and establishing the fundamental importance of co-creation methodologies in the development of scalable interventions to reduce body image concerns and weight bias in physical activity settings. Publications 1 and 2 are systematic reviews that “set the scene”. They examine and synthesise existing research on interventions that aim to improve body image and reduce weight bias in physical activity settings. They identify areas of opportunity in intervention development and the potential of participatory approaches. Publication 1 (Matheson, Schneider, Gentili, et al., 2023) describes a systematic review and meta-analysis of interventions addressing the bidirectional relationship between body image and physical activity among girls and women. Publication 2 (Schneider, Tinoco, Scott, et al., 2024) identifies existing interventions aimed at reducing implicit and explicit weight biases among fitness professionals, the characteristics that underpin their effectiveness, and recommendations for intervention development. These reviews address novel aspects that have not been considered in previous reviews on the topic, such as the bidirectionality of body image and physical activity (Matheson, Schneider, Gentili, et al., 2023) and the exclusive focus on fitness professionals in weight bias interventions (Schneider, Tinoco, Scott, et al., 2024). Publications 3 to 8 address gaps evident in the literature by using participatory and context-sensitive methods to develop body image and weight bias interventions that are inclusive, effective, and responsive to the lived experiences of girls and women in various physical activity settings. Publications 3 to 5 utilise mixed methodologies with key partners (e.g., athletes, coaches, fitness professionals) to identify contextual needs and inform the foundational values and components of inclusive programmes. Publication 3 (Matheson, Schneider, Tinoco, Silva-Breen, et al., 2023) explores girls’ body image experiences in sport across six countries and their preferences for how to improve their experiences. Similarly, Publication 4 (Schneider, Matheson, et al., 2023) investigates coaches’ perspectives on girls’ body image concerns in sport and their preferences for the content and delivery of a body image intervention to upskill them in addressing their athletes’ concerns. These insights contributed to the co-creation of the Body Confident Athletes and Body Confident Coaching interventions. Publication 5 (Schneider, Tinoco, Selmes, et al., 2024) explores fitness professionals’ weight biases and their attitudes toward working with fat people, as well as facilitators and barriers to adopting weight-inclusive approaches. The findings from this study informed the adaptation of a weight bias intervention for fitness professionals. Publications 6, 7, and 8 are concerned with the key role of qualitative methodologies in capturing temporally grounded narratives to offer more nuanced insights on participants’ body image and weight bias experiences to develop more effective interventions for underrepresented populations. Publication 6 (Tinoco et al., 2023) investigates girls’ and coaches’ perceptions of body image concerns in sports environments in Mexico City, as well as what they require from interventions. Relatedly, Publication 7 (Budhraja et al., 2025) explores the body image experiences of Indian athletes and coaches in sports settings. Finally, Publication 8 (Tinoco et al., under review) explores midlife and older women’s gym experiences across their lifespan, to understand how participants make sense of their interactions with fitness spaces and professionals and to identify other social and personal factors that play a role in physical activity engagement. Taken together, Publications 3 to 8 demonstrate the importance of mixed-methods and qualitative research in the co-creation process as a key part in knowledge production that is social and iterative (Agnello et al., 2025). In conclusion, this thesis demonstrates that participatory, co-designed interventions are a viable and impactful approach to improving body image and reducing weight bias within sport and exercise environments. The findings suggest that co-created, contextually grounded programmes can positively influence girls’ and women’s relationships with their bodies and with physical activity. The combination of methodologies grounded in co-creation unpack the key social, cultural, and structural factors that shape embodied experiences and offer practical strategies for fostering inclusive practices. The process of co-creation itself—valuing diverse voices, challenging normative assumptions, incorporating researcher reflexivity, and centring lived experience—is presented as a critical mechanism for developing body image and weight bias interventions in physical activity settings, as well as for expanding this field of research. Future research should explore the integration of empowerment, social learning, narrative, and body-focused self-compassion theories, alongside attention to body-related emotions, to deepen understanding of engagement, motivation, and well-being in physical activity. Strengthening the intersectional lens remains a priority in my research to ensure equitable and inclusive practice, with future work expanding engagement across underexplored identities and continuing to embed participant feedback into intervention design. At a policy level, I am committed to continue supporting body image and physical activity initiatives through relational and institutional change, embedding education within youth sport systems, professional training, and broader public health strategies.

Emerging evidence suggests that weight-biased attitudes are present in early childhood, yet research examining these biases and their association with positive body image in young, diverse populations remains limited. The present study aimed to examine the prevalence of weight-biased attitudes and their relationship with body appreciation among children aged 4–6 years in the United Kingdom and to explore differences by school year, gender, ethnicity, and socioeconomic status. Secondary data analysis was conducted on baseline data from 381 children participating in a randomized controlled trial evaluating media-based interventions for positive body image. Weight-biased attitudes were measured using child-friendly, image-based ratings of peers differing in body size, while body appreciation was assessed with two age-appropriate items. Results indicated that 82.3% of children rated smaller bodied peers more favorably, with the largest differences observed for perceived appearance, intelligence, and dancing skill. Year 1 children (5–6 years) exhibited significantly greater weight bias than Reception children (4–5 years; p< .05, d = −.261), whereas no significant differences were observed across gender, ethnicity, or socioeconomic status (ps > .05). There was a significant negative association between weight bias and body appreciation (rs = −.184, p < .001), suggesting that children who endorsed stronger weight-biased attitudes reported lower body appreciation. These findings highlight the early emergence of weight-biased attitudes and their potential impact on positive body image. Interventions targeting weight bias and fostering body appreciation from preschool years may support healthier developmental trajectories and promote inclusion from an early age.

Body appreciation is a central component of positive body image, yet little is known about its prevalence in pre- and early adolescence. This study examined the prevalence and correlates of body appreciation among U.S. children aged 9–13 years. This preregistered secondary cross-sectional analysis used baseline data from a large intervention trial (N = 1359). Children completed self-report measures of body appreciation, internalisation of appearance ideals, and social media literacy. Prevalence of body appreciation was estimated using a midpoint-based classification approach. Gender and age (9–11 vs. 12–13 years) group differences were examined using independent-samples t-tests. Pearson correlations and multiple linear regression were conducted to examine correlates of body appreciation. Most children reported high body appreciation; however, 18.5% were classified as having low or moderate body appreciation. Older children reported lower body appreciation than younger children. Boys reported lower body appreciation than girls, although the effect size was negligible. Higher body appreciation was independently associated with lower internalisation of appearance ideals, higher social media literacy, younger age, and identifying as a girl, with the overall model explaining 26.5% of the variance. Gender-stratified analyses indicated stronger associations among girls, with age emerging as a significant predictor only for girls, and different domains of social media literacy associated with body appreciation across groups. The findings of this study show that body appreciation is meaningfully differentiated in pre- and early adolescence, highlighting the importance of early, developmentally appropriate interventions that promote positive body image.

Glucagon-like peptide-1 receptor agonists (GLP-1s), including semaglutide and tirzepatide, are rapidly transforming weight management practices and public discourse surrounding bodies, health, and responsibility. Although biomedical outcomes of GLP-1 use are being actively studied, their psychological and sociocultural implications remain comparatively underexamined. In particular, body image has received little systematic attention despite its central relevance to motivations for weight loss, experiences of bodily change, and longer-term psychological adjustment. This paper argues that body image should be conceptualised not merely as an outcome of GLP-1 use, but as a key motivator, mediator, and moderator across the treatment trajectory. Drawing on existing literature on body image, weight loss interventions, weight stigma, and cosmetic procedures, we identify critical gaps in the emerging evidence base and outline priorities for future research. These include prospective and longitudinal studies examining body image before, during, and after GLP-1 use; investigation of individual vulnerability factors and heterogeneity in psychological responses; and analysis of broader societal consequences related to weight stigma, media representation, and inequities in access. We highlight the need for body image-informed psychological support for individuals using GLP-1s, alongside education and training for healthcare and other professionals working with this population. Addressing these gaps is essential to ensure that the expanding use of GLP-1s sits alongside psychological support and wellbeing, rather than reinforcing appearance-contingent self-worth or weight-based harm.