Research evidence now charts the extensive and damaging impacts of dissatisfaction with appearance on physical and psychological health across the lifespan. The negative consequences cut across all key areas of living, including health,social relationships, education and vocational functioning.



The mental health of young people is a major causeof concern in Europe (OEDC, 2010). In recentlarge scale studies, negative bodyimage was cited as a principal component and predictor of lowered self-esteem, emotional distress and depression (Stice, 2002). Appearance is the leading cause of concern for young people in developed countries (e.g. Mission Australia, 2012) and has become central to the self-definition of most women and growing numbers of men.



There are now well established links between appearan ceconcerns and several health- compromising behaviours, including drug and alcohol misuse (Kanayama,2006), the avoidance or over-indulgence in exercise and the use of steroids to increase musclebulk in males (Harper & Tiggeman, 2008). Teenagers with body disturbance are significantly more likely to initiate smoking(Stice and Shaw, 2003) and to use smoking as an appetite suppressant (Arnos & Bostock, 2007). Furthermore, studies have revealed that those with high levels of negative affect and appearance dissatisfaction were more likelyto engage in self harm (Muehlenhamp & Brausch, 2012). Appearance dissatisfaction predicted an earlier initial age of first sexual intercourse in a study of Norwegian girls (Kvalem, et al, 2011).

The rising incidence of diagnosable eating disorders has been recognised, but is only the tip of an iceberg of disordered eating resulting from appearance dissatisfaction. Rates of fasting, skipping meals, self induced vomiting and the use of laxatives, diuretics and diet pills are increasing (Field etal, 2005), particularly amongst adolescents with higher levels of appearance dissatisfaction (Vander Well, 2011).

Increasing numbers are undergoing cosmetic procedures (with concomitant health risks) as a fix for dissatisfaction with appearance, low self-esteemand low social confidence. Psychological gains are short term at best, with many dissatisfiedas procedures fail to achieve their often unrealistic expectations (Sarwer, 2011).



Restrictive eating is associated with a range of detrimental cognitive effects, including decreased attention-span and memory. Students with lower grades are more likely to report that body image concerns interfered withtheir academic performance (Yanover & Thompson, 2008). Lovegrove (2002) found that 31% of UK teenagers avoid classroom debate and 20% absent themselves from school when lacking confidenceabout their appearance.



Following race,gender, and age-based discrimination, weight bias is the fourth most common form of discrimination in many developed countries (Puhl et al, 2008). The rising numbers who are overweight and stigmatised are more likely to experience negative bodyimage, depressed mood and poor self esteem (Keeryet al 2005). Being a victim of weight bias can impact negatively on physical health by placing individuals at increased risk for disordered eating and resistance to physical activity (Vartanian &Shaprow, 2008). Furthermore, overweight and obese individuals often delay seeking health care due to concerns about experiencing weight bias from health professionals (Amyetal, 2006).

One in five people have a condition resulting in a difference in appearance which is visible to others (disfigurement), for example, from congenital defects, disease (skin conditions; arthritis), trauma (e.g. burns), or medical treatment (e.g., the excision of malignant tumours). For many, this ‘difference’ negatively impacts self-esteem and social functioning. The fear of appearance changes can affect treatment decision-making(e.g the uptake of chemotherapy in patients concerned about hair loss) and adherence to medication (e.g. failing to take immuno-suppressive medication following organ transplantation in order to avoid excessive facial hair and bloating).

Appearance issuescan be particularly challenging for migrants and others from socially disadvantaged groups and may contribute to social exclusion.Girls from lower performing schools place more importance on being attractive compared with girls from higher performing schools. In addition, unprecedented levels of debt are incurred amongst lower socioeconomic groups in order to undergo cosmetic surgery (Crerandet al, 2012).

Risk factors for appearance dissatisfaction include a combination of individual and socio-cultural factors. Pressure from the media and from peers is experienced to a greater extent by those who are psychologically vulnerable. However, as debilitating levels of appearance dissatisfaction spread and become ever more ‘normative’, fewer and fewer people are at ease with their appearance. Even those who are resilient to media messages have a grumbling sense of dissatisfaction with their looks and experience mounting pressure to take measures to change their appearance (Rumsey & Harcourt, 2011). 



WG1 Educational settings. This group will focus on harmonising and promoting research in educational settings including compulsory school and higher education. The scope will include research on the prevalence and impacts of appearance dissatisfaction in educational contexts, on the efficacy of interventions to ameliorate or prevent impacts, and on the training needs of teachers and other educationalists.

WG2 Vocational training settings. This group will focus on the collation and promotion of research relevant to the prevalence and impacts of appearance dissatisfaction on vocational training outcomes, on methods of raising the awareness of vocational trainers and counsellors of these negative impacts, and of developing, implementing and evaluating interventions to optimise outcomes.

WG3 Public health. The focus of this group will be to collate the results of existing research and lay the foundations for future research on the physical and psychological impacts of appearance dissatisfaction. Expertise will be shared within the group in relation to how these topics might be addressed within public health settings.

WG4 Health care settings. This group will gather examples of existing research on the prevalence and impacts of appearance dissatisfaction (amongst those with disfiguring conditions, and more broadly, in the wider population) in the health care context, including the motivation to seek treatment (e.g. cosmetic surgery), adherence to medication and satisfaction with the care received. The group will develop resources to underpin future collaborative research and consider ways of raising awareness in health care providers and policy makers of these issues.

WG5 will address Social and Cultural issues relating to appearance dissatisfaction, including the impact of globalisation, the influence of the media and fashion industries, differences in the prevalence and impacts of appearance dissatisfaction between countries and regions in Europe, and the particular pressures experienced by people from socially marginalised and disadvantaged groups. This WG will focus on best practice techniques and the evidence base relating to methods of raising awareness of the extent and impacts of appearance dissatisfaction in policy-makers and practitioners.

The activities of the Working Groups will develop in parallel through the course of the Action, co- ordinated by the Management Committee. Working Groups 1-4 will address the following cross- cutting themes and activities;

a)  Review current research activity and evidence relating to the prevalence and impact of appearance-related distress

b)  Develop common methods of establishing the prevalence of appearance dissatisfaction in the various settings in member countries

c)  Develop common methods of determining the impacts of appearance concerns on physical & psychological health in member countries

d)  Assess the evidence for the effectiveness of current interventions in each setting

e)  Consider the particular needs of minority and socially marginalised groups

f)   Extend the Action to other researchers & practitioners during the life of the Action

 g)  Build relationships & partnerships to facilitate research during and beyond the life of the Action

 h)  Identify key stakeholders and experts and raise their awareness of the extent and impact of appearance dissatisfaction

 i)   Identify potential sources of funding & develop funding bids to underpin future research activities

WG 5 (Society, Culture and Social Activism) will maintain a particular focus on activities e - h. This WG will focus on coordinating current and future research on societal and cultural influences on appearance dissatisfaction, including the impact of globalisation and of the media and fashion industries. Members will consider evidence relating to the effectiveness of techniques designed to produce changes in policy and practice, and will develop resources to facilitate the engagement of key stakeholders and policy makers across all settings.