Module 4: Promoting Mental Health in Adolescence

A Teenaged Girl Concerned with her WeightBody Image

The Concept of Self

Teens mature at different rates and can be keenly aware of these differences, which may cause them to compare their progress with that of their peers. Concerns about appearance can be particularly heightened during adolescence for both males and females. Young teens commonly feel that they are being observed nearly all the time, which causes them to be extremely self-conscious about their appearance.

Because of the close relationship between self-esteem and body image, teens may be concerned about anything in their physical appearance that makes them different from their peers. These concerns are heightened, especially during early adolescence, when large variations in growth and physical maturation occur among members of this age group. Teens need to learn to feel comfortable with their body frames.

Questions to Ask

For the Teen

  • Do you think you are developing pretty much like the rest of your friends?
  • What are some things you like about yourself?
  • How do you feel about the way you look?
  • Do you ever worry about your weight?
    • Do you think you are underweight? Overweight? Just right?
    • Are you trying to change your weight? Why? How?

For Parents

  • What have you discussed with your teen about the physical changes that occur during puberty and adolescence?
  • How do you feel about her weight?
  • What type of physical activity does she participate in? How often?

Provider Tips

  • Explain that there is a high degree of variability in the rate of adolescent development. Point out ways in which the teen is on target developmentally and what she can expect in the next year. If the teen is developing as expected, reassure her of this. Share the teen’s plotted growth chart with the teen and parents.
  • Educate the teen and parents about the physical changes of puberty.
  • During physical exams, specifically address potentially embarrassing problems (acne, enlargement of the breasts in males, asymmetry in females’ breast sizes). Develop a plan to address concerns.
  • Evaluate for underlying medical causes if the teen’s physical development is outside the expected range
  • Address concerns about weight with both females and males. Many teens are dissatisfied with their body shape, body size, or weight. These concerns may result in unhealthy eating habits and use of dietary supplements and anabolic steroids.
  • If you suspect an eating disorder, refer the teen to a registered dietitian experienced in working with teens and/or make a referral to a mental health professional with expertise in eating disorders.
  • Using the guidance listed below, help the teen accept and feel good about her body image.

Guidance for Teens and Parents

For the Teen

  • Everyone has their own unique size and shape and develops at their own pace. When you look in the mirror, focus on all your positive features. Read magazines and look at pictures of models with a critical eye and think about the many unrealistic messages advertisers are sending and what they are trying to sell.
  • When you find yourself focusing on your physical appearance, think about what you like in the people you admire. It’s usually more than just physical appearance— friendliness, courage, loyalty, perseverance, or concern for others.
  • The best way to stay fit and maintain a healthy weight is to eat a variety of healthful foods every day and engage in regular physical activity at least 3 days a week. Physical activity doesn’t have to involve organized sports. Do something you enjoy alone or with a friend—walking, running, dancing, biking.
  • As bodies change, teens often have concerns about their size, shape, breasts, pubic hair, or skin. Be sure to ask your health care provider if you have any questions about these or other concerns.

For Parents

  • Make sure your teen knows that you love her just as she is. Praise her for positive things she does and things she has learned rather than her physical appearance. Compliment her realistically so that she won’t feel she needs to live up to expectations she cannot meet. For example, say “You did such a good job on that project.” instead of “You’re the smartest girl in your class.”
  • Help your teen to achieve and maintain a healthy weight by serving nutritious meals and keeping a variety of healthy foods available for snacks. Encourage her to participate in physical activities and limit the amount of time she spends watching TV or online.
  • Your teen may be trying to improve her body image in unhealthy ways. Look for warning signs that she may have an eating disorder.
    • Distorted body image and extreme dissatisfaction with body shape or size
    • Intense fear of gaining weight or becoming fat
    • Unexplained weight change or fluctuation (greater than 10 pounds)
    • Poor appetite or difficulty eating in front of others
  • Chronic dieting despite not being overweight
  • Binge-eating or self-induced vomiting
  • Fasting or skipping meals
  • Overtraining or compulsion about physical activity

(Source: Bright Futures in Practice: Mental Health)

Resources for Providers and Families

For Providers

Bright Futures Case Studies for Primary Care Clinicians including:

Eating Disorders PDF

Area of Concern – Eating Disorders more information

Eating disorders can result from excessive concerns about body shape, size, and weight and from an unhealthy body image. Eating disorders are more common in females. Early detection of eating disorders can be done in primary care settings by incorporating self-reports into routine health screening and assessment. In high-risk groups (e.g., teens who are dieting, teens who participate in sports that encourage leanness), special efforts should be directed toward increasing knowledge about healthy eating and regular physical activity and promoting a healthy body image. Discuss with teens an appropriate weight range and the importance of obtaining and maintaining a healthy weight. Refer teens for nutrition counseling from a registered dietitian experienced in working with teens and/or refer them to a mental health professional with expertise in eating disorders if indicated.

Resources for Providers

Bright Futures Case Studies for Primary Care Clinicians including:

Area of Concern – Adolescents with Chronic Illness more information

Adolescents with chronic illnesses are at risk for problems with self-esteem and body image. An illness that involves physical manifestations and/or that interferes with sexual development has particular effects on the development of body image. Young male teens whose gonadal development is hampered are at particular risk. Illnesses such as diabetes mellitus, which may not set the teen apart because of effects on appearance, but which impose limitations on lifestyle and independence, can also damage self-esteem and body image. Teens who survive long-term or life-threatening illnesses may consider themselves unattractive, or may have difficulty thinking about their appearance at all. They may struggle to integrate the awareness of their illness with their concept of who they are as persons.

For Families

Body Image Tips for Boys

Body Image Tips for Girls

What is anorexia?

What is bulimia?

Copyright Georgetown University Georgtown University Adolescence