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Governments, schools, and curriculum authorities are increasingly recognizing that body image during adolescence is a public health issue that warrants attention in the school setting.After 30 years of eating disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post test, though effect sizes were small (d = 0.22-0.48). These effective programs were conducted among younger adolescents 12.33-13.62 years, and included activities focusing on media literacy, self esteem, and the influence of peers.Implications for school personnel and curriculum authorities are discussed, and we provide recommendations for a strategic approach to future research in this area. Keywords: body image, schools, intervention, prevention, adolescents Running Head: WHAT WORKS IN SECONDARY SCHOOLS?3 What works in secondary schools? A systematic review of classroom-based body image programs Body dissatisfaction is common during adolescence. Approximately 70% of adolescent girls and 45% of boys want to change their body weight or shape (Smolak, 2012). Australian adolescents have consistently ranked body image as their number one concern in the Mission Australia Survey over the past six years (Mission Australia, 2006. Similarly, levels of body dissatisfaction among adolescent girls in the USA have remained relatively stable since 1999 (Neumark-Sztainer et al., 2012). Body dissatisfaction during adolescence has been associated with a number of negative health outcomes in prospective studies, most notably the onset of dieting and disordered eating behaviors (Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006). Higher levels of body dissatisfaction have also been linked to depression (Stice, Hayward, Cameron, Killen, & Taylor, 2000), smoking (Neumark-Sztainer, , and unsafe sex practices (Schooler, 2012), with effect sizes ranging from small to moderate. The large number of young people affected, the relative stability of this issue over the past decade, and the wide range of deleterious consequences, indicate an urgent and continuing need to develop and evaluate effective body image interventions for adolescent girls and boys. School-based Body Image InterventionsSchools are widely recognized as appropriate sites for interventions to improve body image among adolescents. They offer the potential for sustained interactions with young people at a developmentally appropriate age, where they are already in a learning environment . School-based interventions also offer opportunities to support program materials with environmental changes (Neumark-Sztainer, Levine, et al., 2006), and a whole-school approach to health promotion (O'Dea & Maloney, 2000;Smolak, Levine, & S...

The ubiquitous Barbie doll was examined in the present study as a possible cause for young girls' body dissatisfaction. A total of 162 girls, from age 5 to age 8, were exposed to images of either Barbie dolls, Emme dolls (U.S. size 16), or no dolls (baseline control) and then completed assessments of body image. Girls exposed to Barbie reported lower body esteem and greater desire for a thinner body shape than girls in the other exposure conditions. However, this immediate negative impact of Barbie doll was no longer evident in the oldest girls. These findings imply that, even if dolls cease to function as aspirational role models for older girls, early exposure to dolls epitomizing an unrealistically thin body ideal may damage girls' body image, which would contribute to an increased risk of disordered eating and weight cycling.

The findings indicate that models of eating disordered behaviour, developed for adolescent girls, are also appropriate for understanding this behaviour among male adolescents. The results suggest that social comparisons represent a useful addition to Stice's (1994) original model and a potentially fruitful target for interventions.

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Using combined qualitative data from multiple case study interviews and an online survey, this study explored the impact of appearance change on 22 adolescents receiving cancer treatment aged 13 to 18 years and six of their parents. Data were analyzed using template analysis. Appearance changes were a major concern. Adolescents typically struggled to adapt to new experiences and concerns related to this highly sensitive issue. Many felt anxious and self-conscious and were reluctant to reveal appearance changes in public. These feelings were compounded by the negative reactions of others (e.g., staring, teasing, and inappropriate questioning), which sometimes lead to avoidance of social activity and threats of noncompliance. Parents of these children felt ill-prepared to manage appearance-related anxieties. Adolescents wanted support to develop the practical and social skills necessary to maintain a "normal" appearance and manage the negative responses of others. However, some adolescents showed resilience and, with support from friends and family, developed strategies to manage their altered appearance and its social consequences. These strategies are explored, which can inform interventions to support adolescents and parents.

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