The lived experience of body image in women of midlife aged 45–60 years living in Australia: A qualitative study

Abstract

Background:

Living with body dissatisfaction can have a strong negative effect on wellbeing. This is especially relevant for women of midlife who are feeling pressure to maintain the societal expectations of beauty and the thin ideal. The persistent pressure by Western society for women of all ages to be thin is at odds with the natural biological changes experienced by most women during midlife.

Objectives:

This study gives a voice to women aged 45–60 years, expanding on previous research, to explore and clarify the complexities of body image in midlife.

Design:

An exploratory qualitative design was used.

Method:

Twelve Australian women were interviewed using a semi-structured approach about their experience of body image. Data was analysed using reflexive thematic analysis.

Results:

Four themes were identified: Rational body image versus emotional body image; Weight equals body satisfaction; Ever-present burden of body image; and Limitations of resilience and positive psychology.

Conclusion:

This study highlights the underlying discourse of societal expectations, the burden of normative discontent that persists with age, and the conflict between the rational desire to love one’s body and the emotional body dissatisfaction that impacts women’s lives. Findings provide a deeper understanding of the complex relationship between ageing and body image for women and offer avenues for education and intervention to ensure women can learn to live with greater resilience, undertake self-care and use positive psychology to improve quality of life and to age more optimistically.

Plain language summary

Body image in middle aged women

Living with body dissatisfaction affects the way people feel and participate in life. A large amount of body image research focuses on adolescents and young adults, however negative body image and low self-esteem also impact women as they age. There is pressure on women of all ages to be thin, even though their bodies naturally change as they get older. This research gave Australian women aged 45 to 60 the opportunity to express their thoughts and feelings about their bodies in middle age and describe ways that this impacts their lives. Twelve Australian women were interviewed and the content from these interviews organised into related themes. Four themes were identified: Many women logically know they should feel good about their body while simultaneously disliking it; The connection between weight and how they see their bodies; Permanent dissatisfaction about appearance; and Resilience and positive psychology not being enough to help them feel good about their bodies. This research complements qualitative findings from other female samples that report women feel society expects them to look a certain way, which negatively impacts them across life stages. This study helps us better understand how body image affects women as they get older and offers some ideas for how to help women feel more confident about their body as they age.

Introduction

Women are vulnerable to body dissatisfaction and poor body image across the lifecycle. A substantial body of research focuses on the experiences of adolescent girls and young women, yet less is known about older women. ¹ Midlife is defined as the age 40–65 in most Westernised cultures, ² a time that brings physiological changes for women’s bodies, including the onset of perimenopause, changes to body shape, weight gain, wrinkles and greying hair, ³ all of which contradict Western expectations. ⁴ These changes are experienced at a time when Western societies’ pressure on women to conform to sociocultural expectations of beauty is salient, with an emphasis on the thin ideal ⁵ and the importance of youthful appearance.^6,7 Some research indicates women report greater resilience to negative body image during midlife, while other findings indicate women are substantially affected during this life stage.^8,9 Further consideration of how Australian women of midlife are experiencing and managing body image is warranted.

Body image refers to one’s perceptions, feelings and beliefs about their body.^10,11 It can incorporate evaluations of attractiveness and body size estimation, including the associated emotions this elicits. ¹⁰ Body image perceptions can be a complex and multifaceted attitudinal experience. ¹² For example, when one perceives their body in a negative light, they are likely to experience negative affect and cognitive impacts. ¹² Theoretical constructs that assist the understanding of these impacts include the internalisation of the thin ideal and Festinger’s Social Comparison Theory.^13,14 Internalising the thin ideal refers to individuals cognitively accepting and striving to attain the culturally endorsed ideal of thinness as a personal standard. ¹⁵ This internalisation has been associated with body dissatisfaction and increased risk for disordered eating behaviours.^12,16 Festinger’s Social Comparison Theory ¹⁴ proposes that individuals determine their own social and personal worth by comparing themselves to others, including peers, family and those in social media. The comparisons can be upward (to those perceived as better off) or downward (to those perceived as worse off), with both directions influencing self-esteem and motivation. ¹⁴ Women are consistently seen to engage in upward comparison of their bodies as ‘less than’ when compared to sociocultural standards. ¹⁷ The Tripartite Influence Model posits that these points of comparison can lead to body image disturbance for some. ¹⁷

Fredrickson and Robert’s Objectification Theory ¹⁸ further posits that women in Western culture can often be the subject of objectification by men (and others).^19,20 As a result of persistent objectification, women learn to view themselves as objects to be looked at and evaluated, internalising the standards they may be measured against. ²¹ This process is known as self-objectification and often results in increased body monitoring and surveillance. ²¹ In their self-surveillance, women may then assess their bodies as observers do, with increased focus on and worry about how their body looks to others rather than how it works or feels for them. ²¹

Research supports the association between body image and psychological factors such as self-esteem, internalisation of the thin ideal, social comparison with idealised models and self-surveillance. ¹⁰ Body dissatisfaction, which encapsulates negative thoughts about and feelings towards one’s body, may be experienced as a continuum ranging from lower to higher levels of distress resulting from negative thoughts about and feelings towards the body. ²² Some research suggests that lower levels of body satisfaction may be beneficial, leading to increased exercise and improved nutrition, ²³ however, some women with a negative body image report symptoms of low self-esteem, anxiety, depression and sometimes disordered eating.^22,24

Understanding of the way women are affected by body image is largely informed by studies in adolescent and younger females. However, evidence increasingly identifies substantial body dissatisfaction in midlife women, with considerable complexity found in how they navigate their body image.^8,25 A large survey of American women aged over 50 years reported shame and dissatisfaction with ageing, with some women able to reconcile negative emotions with a focus on body functionality. ⁸ Gosselink et al. reported that women aged 17–91 years perceived age-related body changes negatively and saw the changes as a loss of control, health and identity. ²⁶ Further, these women considered that accepting the ageing body, although admirable, was difficult given society’s promotion of youthfulness, leading to a circular negativity towards body image. ²⁶ Women report that resisting the pressure of sociocultural norms is challenging and they engage in activities attempting to mask the physical signs of ageing. ²⁷ Therefore, it may be anticipated that body dissatisfaction becomes worse with the normal ageing process, as women move further away from the sociocultural body ideals. These pressures can have a lasting effect on body image and a detrimental impact on physical health and wellness. Impacts on quality of life include negative health behaviours (e.g., disordered eating) and psychological effects such as anxiety, sleep disturbance, reduced self-esteem and psychosocial impairment.^28–30 Taken together, these findings suggest that significant work is required to help ageing women manage their body dissatisfaction.

In addition to impairing quality of life, negative body image can lead to disordered eating and eating disorders, which can have enduring and severe impacts on physical and mental health.^25,31–33 Disordered eating is defined as a range of eating behaviours, such as dieting or food restriction, which are common, to more severe restriction of intake and behaviours such as binge eating and purging, which are clinical eating disorders.^33,34 The concurrence of negative body image and disordered eating is pervasive and well documented for adolescents and young women; however, a greater understanding of these issues is required for women in midlife. ³⁵ One Australian study examined factors associated with body dissatisfaction and disordered eating in 200 women aged 35–65 years, finding that women aged 54 years reported the highest level of dissatisfaction compared with retrospective reports from their adolescence, 20s, 30s and 40s. ³² In addition, nearly 80% of the sample wanted to lose weight despite being in a healthy weight range, suggesting that body dissatisfaction and disordered eating remain high in midlife. ³² Hay et al. found that women aged 45–54 years reported regular episodes of bingeing, purging and strict dieting or fasting. ³⁶ This highlights that body dissatisfaction is a significant burden for women, which continues to impact their quality of life and mental and physical health throughout their lifespan. Becker et al. suggested that researchers may find higher levels of body dissatisfaction in older women over time, with the growing influence of social media and diet culture that was not experienced by previous generations. ⁶

As women age, they are regularly exposed to media and social interactions that remind them of their deviation from the young, thin ideal, threatening perceptions of their own body to become negative. ³⁷ Perloff suggests that social media is the predominant online medium where girls and women witness unattainable body standards that reinforce their own body image ideals. ³⁸ Life lessons, attitudes and body image concerns are being cultivated through the infiltration of social media in individuals’ lives, which are then metastasising into convictions. ³⁹ Bandura’s Social Cognitive Theory ⁴⁰ explains how women learn that their bodies differ from the thin ideal by observing and internalising sociocultural messages, especially from media that promotes unrealistic body standards. ⁴¹ Through repeated exposure, women adopt these ideals, shaping their body image and self-perception.^40,41 The omnipresence of unrealistic body images can result in pressures to conform, increased negative affect and persistent social comparisons. ³⁹ Women may go on to internalise these images, promoting self-objectification that can lead to social comparisons and increased body dissatisfaction. ³⁹

Despite the majority of research showing body dissatisfaction as being pervasive across the lifespan, there are some studies indicating that body appreciation may improve as women age. For example, Tiggemann and Lynch posited that as women age, body image becomes less important and that ageing brings with it greater acceptance of self. ⁴² More recent research by McLean et al. contends that life experience and maturity bring heightened cognitive strategies that result in a perceived reduction in vulnerability when used by women to cope with the cultural ideals of beauty. ³² It appears that some developmental factors may offer a protective element by diverting attention away from concerns such as body image. ³² Life experiences such as being in a secure long-term relationship, having children, and having a secure career may reduce risk. ⁴³ The development of cognitive strategies to manage changes may include secondary control; one’s ability to accept circumstances and adjust to the environment by changing expectations, reappraising and practicing acceptance.^44,45

Few studies focusing on how Australian women in midlife view and experience body image have been published in the past 5 years. The present study aims to increase understanding of body image in women in midlife (here considered 45–60 years of age). These interviews aim to explore Australian women’s perspectives of their bodies and understand how this changes during midlife.

Method

Design

This was an exploratory qualitative study employing semi-structured interviews and reflexive thematic analysis. The study was approved by the University of Canberra Human Research Ethics Committee (Project ID: 7060). It is reported according to the Consolidated Reporting Criteria for Reporting Qualitative Research (COREQ).

Participants

Women aged between 45 and 60 years residing in Australia were eligible to participate. This age group was chosen as a subset based on the extensive review of research that defines midlife as ages 40–65. ² Twelve women aged 46–60 years completed interviews. Characteristics of participants are summarised in Table 1.

Table 1.

Participant characteristics.

Pseudonym	Age	Relationship status	Children	Highest education
Greta	48	Divorced and re-partnered	2	University degree
Rose	54	Married	2	TAFE certificate
Betty	49	Divorced and currently single	1	University degree
Aimee	55	Divorced and re-married	5	Diploma
Hanna	55	Married	2	Yr 12 certificate
Hope	46	Divorced and currently single	4	University degree
Roxy	54	Married	3	University degree
Cara	55	Married	4	University degree
Marley	54	Single	Nil	University post-grad diploma
Stella	58	Widowed and re-partnered	3	TAFE certificate
Kitty	60	Single	Nil	University master’s degree
Eve	53	Married	4	TAFE certificate

Procedure

Posters advertising the research were placed in a women’s only gym, a local shopping centre, a local café, on social media and at a university. Participation was voluntary, no incentives were offered and relationships were not established prior to the commencement of the study. Inclusion criteria included age, gender and citizenship. These elements would also inform any exclusions, however, no exclusions were needed based on the volunteers who presented. All participants initiated their interest via email. Details of the research being part of the key researcher’s honours degree were provided prior to participants agreeing to the conditions of the study and all provided written informed consent prior to being interviewed. Semi-structured interviews were conducted either face-to-face in an office, or the participant’s residence, or using an online platform. An interview guide that was developed from a thorough review of literature and discussion within the research team was used (see Appendix 1). Participants were asked to share their experience of body image through their lifespan and the impact that ageing has had on their body, attitudes and feelings. The interview guide was tested with a research peer for understandability and flow before commencing the first interview. All interviews were conducted by the same researcher, MZ and no non-participants were present.

An iterative approach was taken, so that interview questions were refined and adjusted throughout the interview process. ⁴⁶ This allowed participants to share experiences and perceptions most relevant to them with minimal influence from the interviewer. ⁴⁷ Interviews were conducted over May and June 2021; they lasted between 27 and 93 min, with a mean length of 46 min.

Data analysis

Data was analysed thematically, guided by Braun and Clarke’s approach to reflexive thematic analysis. ⁴⁸ Our research is influenced by a constructivist epistemology that recognises that reality is created through engagement with the social world and multiple realities are possible. Reflexive thematic analysis was an appropriate option for generating shared meaning between participants and researchers. ⁴⁸ MZ listened to the recordings and checked transcripts for accuracy. Participants were provided with a copy of their transcript and invited to make amendments or additions; however, no participant modified the initial transcript. After completion of 10 interviews, MZ, VL and MM read transcripts independently and made preliminary notes about content and meaning. Initial reactions to transcripts were discussed collectively to generate codes from within the data. Themes were identified collaboratively by the research team. MZ maintained a map of themes, codes and quotes in a spreadsheet. Following preliminary analysis of the data from the first 10 interviews, it was considered that the data provided sufficient depth for analysis and it was unlikely that more interviews would elicit new themes. However, an additional two interviews were undertaken to test this assumption. The quality of the data was assessed using the concept of information power posited by Malterud et al. ⁴⁹ Where clear, unambiguous dialogue occurs in qualitative studies producing empirical data, co-constructed through complex and trusting interactions between the researcher and the participant, greater information power is achieved. Based on these conventions, the sample size of 12 was considered sufficient.

Trustworthiness and reflexivity

To optimise the quality and trustworthiness of our research we considered Braun and Clarke’s guidance on quality reflexive thematic analysis. ⁴⁸ We recognise that the personal beliefs and assumptions of the researchers can influence analysis and that our understanding has been co-created with participants. The research team was led by MZ who holds a university degree and at the time was a 53-year-old, divorced Caucasian woman with three adult children undertaking an Honours degree. The team discussed findings collaboratively and challenged interpretations. We allowed space between the initial and final analysis to review if our findings remained strong and embedded in the data. We maintained a comprehensive map of themes, codes and quotes.

Results

Four themes with 10 sub-themes were identified during the data analysis (see Table 2), capturing participants’ lived experience of body image, sociocultural pressures, menopause and ageing. The themes are: (1) rational body image versus emotional body image; (2) weight equals body satisfaction; (3) ever-present burden of body image; and (4) limitations of resilience and positive psychology. Exemplar quotes are used to support the theme descriptions, with additional quotes used to express participants’ thoughts and feelings more fully. Pseudonyms are used throughout.

Table 2.

Themes and sub-themes identified in interviews.

Theme	Sub-theme
1. Rational body image versus emotional body image	1.1. Lifelong impact of negative body image despite intent to unconditionally accept self
	1.2. Social comparison and the inability to live up to beauty ideals
	1.3. Women have compassion for others but are their own worst critic
2. Weight equals body satisfaction	2.1. Body image is tied to the number on the scales
	2.2. Midlife body changes associated with age
	2.3. Persistent influence of family and childhood
3. Ever-present burden of body image	3.1. Body dissatisfaction is persistent
	3.2. Hindsight is wonderful – perspective improves over time
4. Limitations of resilience and positive psychology	4.1. Some strategies improve poor body image; however, the issue remains
	4.2. Reflection and gratitude can help – an area for improvement for most

Theme 1: rational body image versus emotional body image

‘The way I feel about myself is. . .I feel like a piece of rotting meat. And that was how I felt about myself physically and who I was, I identified with that totally, totally sort of unacceptable’ (Aimee).

Women in the study reflected on their feelings about their bodies during midlife. There was a strong sense of conflict between their rational mind which desired to be satisfied or to love their own bodies and the contrasting emotional view of dissatisfaction, discontent and in some cases disgust about their bodies. Kitty, like many of the women, tried to be rational, saying ‘you know, you’re not your body and, you know whatever you are, you bring your wisdom with you’. Three sub-themes were identified (summarised in Table 3). Women spoke about the lifelong impact of negative body image despite intent to unconditionally accept self. They expressed a desire to be comfortable in their body and love the skin they are in. Their rational cognitions about body image, in spite of their feelings, may be the product of women having lived and survived their own personal struggles with weight and body image. Overwhelmingly body image is intrinsic to how women feel about themselves as people.

Table 3.

Quotes exemplifying theme 1: rational body image versus emotional body image.

Sub-theme	Supporting quotes
1.1. Lifelong impact of negative body image despite intent to unconditionally accept self The participants unanimously expressed a desire to be comfortable in their body and love the skin they are in. Their rational cognitions about body image, in spite of their feelings, may be the product of women having lived and survived their own personal struggles with weight and body image. Overwhelmingly body image is intrinsic to how women feel about themselves as people.	‘The best life drawing model I ever had was a woman that was highly voluptuous . . . I loved drawing her the most because she was the most feminine person I drew. But then to come back to my own body and acknowledge my femininity had to be stick-like to be acceptable. So, there’s like a fight all the time’ – Aimee on the dichotomy of the rational and emotional fight experienced by women. ‘Body changing [with age] is a natural progression, we are all on the same trajectory, we need to, should embrace it’ – Greta. ‘Be comfortable in your own body and you will be a better person, more confident. Don’t worry about other people’ – Eve’s advice to younger women. ‘For the older women, we’re under a lot of pressure to look better than we naturally do. . . I’d wear big clothes and not be at the pool with the children as much, which is a shame, that you make those kinds of choices based on how you think you look, and how you think other people are looking at you and judging’ – Stella, on the limits imposed by her self-consciousness in ageing. ‘When I go to the beach with my family, well that’s why I basically starve myself, so I look acceptable at those times. I never judge others poorly, but I judge myself. . . “so then by the time I was about 15, I was trying to make myself vomit because that was. . .I guess all I could control” – Aimee, describing how her negative body image led to disordered eating.
1.2. Social comparison and the inability to live up to beauty ideals Participants reported experiencing upwards social comparison on social media resulting in negativity about their own bodies. As women age, some describe a sense of a pending expiry date. Midlife brings a period where women are no longer looked upon favourably by others and cannot live up to the beauty ideals demanded by society.	‘Society wants thin, ideal, young, beautiful, perfectly proportioned women. . .I’m never going to have the Instagram-worthy bikini clad body’ – Greta, who feels pressure to achieve the unattainable. ‘Media, magazines, and Instagram present unrealistic versions of what women should look like’ – Cara. ‘I have never been an ideal weight. Magazines with those ridiculous figures that you read about, if you’re this tall you should be [weigh] this, and I’ve always thought if I look like that, I’d look horrible’ – Hanna, who still falls into the trap of upward social comparisons. ‘I’ve hated becoming invisible to the opposite sex. I’ve hated that. I’ve always felt like I’ve been someone that has been able to attract attention like that. But because I’ve aged now, I’m invisible’ – Hanna discussing the perceived inability to meet beauty standards as she ages. ‘I feel like women have a shelf life and once they hit that shelf life, they’re parked’ – Greta.
1.3. Women have compassion for others but are their own worst critic Participants showed comradery and compassion when talking about other women, but were unable to apply this to themselves.	‘They look great, and I have no judgements. . . I think we are our own worst critics’ – Greta, who mostly avoids the beach due to her body image, describing her thoughts when she sees larger women there. ‘They all look beautiful and just really wish that women would stop being so hard on themselves’ – Hanna, about her girlfriends. ‘I think that exposure as well has helped. . .sometimes I think people get caught up in the negativity of being naked. But going to a nudist beach, you see every type of body you can possibly imagine, and that’s also a leveller as well’ – Rose, about her visits to nudist beaches.

Theme 2: weight equals body satisfaction

“I liked the feeling when I was 57 kg, my lightest, and it’s taken me time to come to terms that I’m not supposed to be that way. I could buy clothes off the shelf, I liked my little physique, I felt healthier. When I was larger, I was disappointed and was failing myself” (Betty).

Most participants value their appearance, wish to maintain a certain body weight and strongly associate their weight with body satisfaction. It is hard work and takes time and commitment and being unable to meet a desired weight feels like failure. Three related sub-themes were reflected by participants, (2.1) Body image is tied to the number on the scales; (2.2) Midlife body changes associated with age; (2.3) Persistent influence of family and childhood which are supported by quotes in Table 4.

Table 4.

Quotes exemplifying theme 2: weight equals body satisfaction.

Sub-theme	Supporting quotes
2.1. Body image is tied to the number on the scales Women described a strong connection with their weight and could recall their weight at certain points in their lives, which has negatively impacted their body image. Single participants worried their weight would interfere with finding a partner and maintaining a happy relationship.	‘When I am at this certain [weight] I’ll be normal and I’ll be slim and happy, but it never, ever, you never get there’ – Hope, describing her perceptions of weight. ‘People always say, oh you look good. Have you lost weight? You know that whole kind of culture where, just because you look good, you must have lost weight’ – Marley, discussing the importance placed on weight by society. ‘[I am] constantly in a state of losing weight to maintain relationships and meet expectations. Because I was carrying a lot of weight, I felt really inadequate about myself and the whole hate myself stuff [starts up] again, so I starved myself again and I’d just drink black coffee all day and not eat, and I lost a lot of weight, and then of course I became more acceptable to him’ – Aimee, describing the impact of weight and body image on her relationships.
2.2. Midlife body changes associated with age There was some discussion and acceptance about body changes associated with age such as wrinkles, ageing skin, and the appearance of cellulite, however there was limited interest voiced in having cosmetic procedures to rectify these. Menopause also affects weight distribution for some women which was the primary focus of many participants.	‘So I’m actually 68 and a bit kilos and I’m scared. I think, oh my God, I’m in that menopause time, am I going to be able to lose it? Is it just a downward slope now? . . . I’m a bit freaked out by it all’ – Marley. ‘I think for me, I’ve always been very body conscious, I’ve been very proud of my body because I was happy, incredibly fit, and healthy. And all of a sudden you kind of feel like you’ve lost control of it. The things I can’t change, the things that are a natural part of ageing that it doesn’t matter how many sit ups I do or how many steps I take, they will not make a difference. And this can really affect my ‘whole image’ about who I feel I am. For me the menopause is psychologically scary’ – Roxy. ‘I don’t do any of it. It’s something I’ve thought about, but then I think, well why? I am who I am, the wrinkles on my face show a story’ – Betty, not interested in cosmetic interventions. ‘I look at movie stars and people like Susan Sarandon, and I actually would love to be like her. No, I’m actually turned off by a lot of plastic women, and I notice the older I get the more angry I am that that’s what we’ve been bombarded with, and I reject that’ – Hope, despite her ongoing challenge with disordered eating.
2.3. Persistent influence of family and childhood Women report their perceptions about body weight and body image were influenced during their childhood by family, particularly by their mothers. Participants shared how they were spoken to about their appearance and the longstanding impact on their eating habits and body image. In some cases, this led to serious disordered eating issues.	‘My mother would be quite critical of me, well that’s why you’re getting fat blah blah, because you are eating too much. So, my mother just wouldn’t put food in the cupboard. . . [I] didn’t have a good role model for how, what, and when to eat’ – Betty whose mother was highly self-conscious about her own body image and constantly on a fad diet. “[My] mother didn’t want fat lazy children” so would portion out food for herself and her brother. Hope explained “there was a lot of shame[ing]” from her mother and grandparents. Following an illness causing Hope to vomit for several days, she recalls her mother exclaiming, “you’ve lost your puppy fat off your face, you’re not looking as puffy! You should try and stay that way” – Hope attributes this as the start of her lifelong relationship with disordered eating from the age of 12. ‘So, from a little kid inside, you internalise that. . . you were basically fat, or displeasing, or something to be made fun of, and your skin was just atrocious. . . so you were basically, what good are you?…it’s just all these little messages going in, of self-hate building up. It was just really horrible, a horrible time and very inadequate parenting’ – Aimee, who recalls feeling ‘fat in their eyes’ speaking of her family. Greta feels that society focuses on what an ‘ideal female body should look like’ and expresses that she encourages her daughter to ‘feel beautiful as she is, [and that she] doesn’t need to conform to any particular image’.

Theme 3: ever-present burden of body image

‘I don’t know whether I’ve ever liked myself, I’ve never really liked my body, liked much about my body’ (Kitty).

A clear message that underpinned the data was that body image, body dissatisfaction and discontent are ever present. This starts at a young age for many and continues throughout their life. While some participants shared that they were not overly worried about body image, the underlying discourse is one of challenge from societal expectations and normative discontent, even for those who may not have outwardly identified with it. There were two sub-themes that came through the data: (3.1) Body dissatisfaction is persistent; (3.2) Hindsight is wonderful – perspective improves over time, which are substantiated by quotes in Table 5.

Table 5.

Quotes exemplifying theme 3: ever-present burden of body image.

Sub-theme	Supporting quotes
3.1. Body dissatisfaction is persistent Women described enduring concerns about their bodies and a burden that is never far from their thoughts. While there may be a brief reprieve during pregnancy, women typically think about their bodies and compare themselves to others in an endless discourse over their lifespan.	‘I’m interested in, you know as you get older how you think about how you look, but also how you own that in a world where other people get to have an opinion about what women’s bodies look like far more than. . . .women’ – Cara, on society’s desire for the thin ideal. ‘Sexualisation of women coming through all pores of existence – it sells’ – Greta, who is negatively impacted by unattainable expectations of women’s figures. ‘Really feminine and curvaceous’ – Greta describing her positive body image during pregnancy. ‘All the way through my pregnancies I struggled with weight… I was overweight and how would I get rid of this weight. . .I look awful and so that all went on. . . I don’t feel like I’ve got a very positive body image at all. I haven’t. I mean, I shower in the dark so I can’t see myself, I never let him see me in light’ – Aimee describing the persistent nature of her negative body image during and after pregnancy. ‘It’s like a whole new world’s opening up. . . it’s so nice… with age you know, nice. And I think just with age you become more confident anyway, don’t you? I hope to more just accept myself. Maybe my acceptance of my body and my figure and my shape will just come; it’s going to come along behind that’ – Hope describing her optimism as she ages.
3.2. Hindsight is wonderful – perspective improves over time Almost unanimously participants look back at their teenage or young adult years and are surprised at how good they did look; they were slim and beautiful. The women recognised the need to change the discourse for themselves and future generations.	‘I had a good body, and I wish I was confident in it and took the opportunity to flaunt it. I wish I had worn that bikini’ – Eve on her previous figure. ‘God, I thought I was fat or something then and I was absolutely amazing. So, it’s funny how. . .when I was 18 or 13. . . I was so self-conscious’ – Marley. ‘Yeah, if I could change [my perceptions], it would be to have self-belief. And I think that [a] huge issue in self-belief is your body image, it plays a huge role because if you go out into society and you feel unacceptable, that becomes all through you’ – Aimee. ‘It is less about the weight, it’s probably one of the things that most women have got to learn, is that when you’re really comfortable with yourself and happy, it’s just attractive. You don’t have to be perfect’ – Marley.

Theme 4: limitations of resilience and positive psychology

‘If you want to be a mermaid, you be a mermaid. If you want to be a unicorn, you be a unicorn’ (Rose).

The women were asked to identify strategies that support a more positive attitude towards body image. This proved difficult for some participants to answer. It appears self-care is not a priority for many women, and they tend to put others first, often leaving limited resources available for themselves. Two sub-themes that were identified from this data: (4.1) Some strategies improve poor body image; however, the issue remains; (4.2) Reflection and gratitude can help – an area for improvement for most, which are supported by quotes in Table 6.

Table 6.

Quotes exemplifying theme 4: limitations of resilience and positive psychology.

Sub-theme	Supporting quotes
4.1. Some strategies improve poor body image, however, the issue remains Women identified self-care and creative activities as ways that help improve their body image, suggesting that the small things often help women feel better about themselves. However, it seems these small self-care activities have limited impact on improving body image over time. Seemingly, participants did not believe that incremental positivity can improve wellbeing and positive body image.	‘I paint and I write, I get a lot of joy in expressing. I also go for big walks and take photos of animals and the trees, and that gives me a lot of peace’ – Hope. ‘I’m a real walker. I love going for big walks with the dog. That definitely lifts my spirits. I love people, so I organise to go and catch up with a friend or something. It’s camaraderie’ – Hanna. ‘[My friends] generally help each other out with ageing’- Rose ‘Not getting bogged down in the things that are not important. Don’t know how I’m going to do that?’ – Marley
4.2. Reflection and gratitude can help – an area for improvement for most Gratitude and reflecting on positive aspects of their lives did not provide much support for most participants. However, some women thought gratitude and positivity can assist with improving body image. Betty finds it important to choose activities that make you feel good.	‘It is important to find that bliss’ – Betty, on finding activities that make her feel good. ‘I still might be big, and I still might not like who I am in the mirror. . . you know, there’s a part of me in the body image stuff that on a physical sense I don’t like me, but on a soul sense, I’m really loving me’ – Kitty. ‘[Look after] mental health, your emotional health, your social health, just look after all the aspects of yourself, your life. . . try and make yourself happy’ – Marley’s advice to other women. ‘Find something that gives life meaning, and feel good about whatever it is you’re doing, and that will give you the confidence to feel good about who you are. And if there’s something you don’t like, find a way to change it, but without going under the surgeon’s knife’ – Roxy.

Discussion

This study deepens the understanding of the lived experience of body image in Australian women in midlife, an under-researched group. The use of face-to-face semi-structured interviews allowed participants to reflect on and explore their experiences of body image. Participants voiced conflict between rational and emotional body image, a strong connection between their weight and body satisfaction and a persistent burden of body dissatisfaction throughout their lifespan. While participants shared strategies that fostered resilience, these did not fully rectify poor body image.

The relationship women have with their bodies is challenging and complex, particularly in midlife when women feel pressured to keep the visible signs of ageing at bay. ²⁴ This was expressed by participants in this study who experienced body image issues throughout life that were exacerbated or changed by midlife. While participants had a strong sense that they should accept and even love their ageing bodies (theme 1), they found it hard to apply this to themselves. Participants’ responses aligned with the research by Gosselink et al. ²⁶ that showed women are often negatively impacted by society’s promotion of youthfulness, the thin ideal and unattainable beauty expectations. This corresponds with the results found by Becker et al. ²⁸ where most of the women in the research reported negativity about their weight or shape, and had feelings of being worried, upset and some felt shame. Results of the current study not only verified that body image issues persist in midlife, but also shed light on the amount of work still needed to improve how women manage body image and the negative impacts of their body dissatisfaction in midlife and beyond. Roxy shared ‘when your body has been very central to you and who you are, it’s been very much part of your identity. . . . to feel less secure because of the impacts of menopause. . . . it’s hard to talk about’.

The findings exemplified Festinger’s Social Comparison Theory ¹⁴ with several women reporting that they routinely assess their bodies against childhood friends, peers, family and media images through social comparison. Participants spoke about this persistent comparison behaviour contributing to body dissatisfaction and poor self-esteem. Their narratives about an inability to live up to unattainable beauty ideals and societal norms were in line with previous research identifying that internalising the thin ideal ultimately increased body surveillance and body dissatisfaction. ¹³ Participants voiced a level of compassion and lack of judgement of other women, with an underlying sense of camaraderie or sisterhood threading through the discourse. However, this compassion was not extended to themselves. A subset of the participants highlighted feeling that the ageing woman becomes invisible or irrelevant. Some of the women described how blindsided they felt with the changes that come with midlife, while others shared how ageing has left them grieving the younger, beautiful body and they feel unwilling to accept the changes that have come with age. Hope shared that ‘my body image or the image I have of my body over all these years has been harsh, not kind to my body, and that makes me really sad’.

Weight was inextricably intertwined with body satisfaction for this sample of women (theme 2). Numbers on the scale were strongly linked to how participants felt and how they behaved at various weights, with women recalling their weight at key stages of their lives. Participants’ engagement with life was considerably impacted by their perceptions, feelings and evaluations of their bodies. For example, some participants disliked wearing swimwear so much that they either avoided the beach all together, avoided photographs, or severely restricted their food intake prior to holidays to cope. Participants shared the overwhelming presence of their preoccupation with weight concerns and a lifetime effort to control weight. Many participants were especially dissatisfied with the loss of control, as well as weight and body composition changes occurring with ageing. ‘It is harder when you get older to transition from that, you know, being that really beautiful girl to just, you know, I think I’m not invisible yet, but you know, probably going to get there at some point’ shared Marley about her struggle with the sense of loss of the young, beautiful ideal. This finding echoes the work of Saucier, who describes how the physical changes of ageing give rise to a perceived loss of attractiveness and displays of ageing anxiety. ⁵⁰ The finding also corresponds with the work of Gagne et al. and Allaz et al. who both identified high levels of weight dissatisfaction in midlife.^25,51

There was a strong theme of childhood experiences, family and especially mothers having a lasting and negative impact on the body image of women. For one participant, this coincided with a lifetime of bingeing and purging. Neumark-Sztainer et al. suggest that daughters emulate their mothers, given that they are their primary models. ⁵² Young girls observe and internalise their mother’s ‘fat talk’ (e.g. ‘I feel so fat’ and ‘I need to go on a diet’) and persistent comments about themselves and to others about food, weight and the desire to be thin.^53,54 The behavioural manifestation of ‘fat talk’ has been linked to self-objectification, body dissatisfaction and a drive for thinness. ⁵⁵ These findings, along with those of Vaughan-Turnbull and Lewis ²¹ , demonstrate how children learn to take on the observer’s perspective, assess their bodies the way observers do, which in turn increases the worry about how their body looks to them. This is in accordance with Fredrickson and Robert’s Objectification Theory. ¹⁸ Betty found her ‘Mum always on fad diets. Mum was always aware of her body image. Grandmother was very slender. Our cupboards were never full. As I was underfed in my teens, I think it contributed to the fact that I battle weight, it goes up and down’.

Grounded in Bandura’s Social Cognitive Theory, ⁴⁰ the women in this study appear to have observed, modelled and engaged with their mothers’ communication and behaviour in ways that resulted in negative outcomes. ⁴⁹ This saw some participants battle with poor self-esteem, body dissatisfaction, weight cycling and disordered eating. For example, some women in the study shared their experiences of being teased by family members, including parents, grandparents and siblings, which led to ongoing poor self-esteem, body image and body satisfaction. These results are supported by previous studies finding that appearance-related teasing in adolescence increases the risk that one will experience body dissatisfaction and engage in disordered eating behaviours.^31,56

The findings of the current study demonstrate women’s normative discontent with their bodies (theme 3), supporting the construct originally posited by Rodin et al. ⁵⁷ and further explored by Tiggemann. ⁵⁸ Women in this study spoke of a body dissatisfaction burden that has persisted throughout their life and not abated with age. Their narrative aligns with Kilpela et al. ⁵⁹ and Slevec and Tiggemann ³³ who found that most midlife women had a level of body dissatisfaction and a drive for thinness. The omnipresence of unrealistic body image and demands to conform to Western ideals is documented extensively in the literature,^39,60,61 which promotes self-objectification and leads to increased body dissatisfaction. ³⁹ Unfortunately, this dissatisfaction exacerbates the pressures recognised by Jankowski et al. ²⁹ for women to age gracefully at a time in their lives when Western culture is starting to devalue them. ⁶⁰ This likely contributes to the feelings of being overlooked and invisible expressed by participants.

Although some evidence suggests that a greater appreciation of one’s body can come with age, ⁶² most participants in this study did not express that appreciation. However, one participant stood out, identifying her body satisfaction, even though she was frustrated with the changes she was experiencing with menopause. She spoke about feeling at odds with other women’s experiences to the point that she often felt reluctant to outwardly show her satisfaction and happiness with her body around other women. The participant expressed that because society expects her to be unhappy, she shields those around her by not articulating her body satisfaction. Marley is frustrated and wants women to see ‘one of the things most women have got to learn is that when you’re really comfortable with yourself, happy, it’s just attractive, you don’t have to be perfect’.

Hindsight has provided a few participants with the knowledge of just how wonderful they did look when reflecting on their younger selves. Collectively, the women wished they could have seen that at the time, and ‘rocked the bikini’. The majority of participants now recognised that they were caught up in their negativity, fat talk and societal expectations, and that they missed the times when they felt absolutely fabulous. However, this realisation did not seem to influence a greater appreciation of their current body in midlife. They continued to carry their body dissatisfaction with them and could only view their body positively in retrospect.

Positive body image, a feeling of respect and love for the body, was displayed by only a few women. Positive body image can include an appreciation for the body’s unique beauty and function, acceptance regardless of any divergence from societies’ idealised images, comfort in one’s skin displayed as a quiet confidence, and the ability to reframe or reject negativity with optimism. ³⁷ For example, some participants reported engaging in self-care and positive psychology to improve their body satisfaction and happiness (theme 4). This complements previous research asserting that self-care behaviours may increase women’s respect for their physical and emotional wellbeing and that modest levels of dissatisfaction may lead to greater agency, positive adjustment and wellbeing.^23,63 Similarly, Gillen ⁶⁴ proposes that engaging in activities such as unwinding with music or reading, walking, or dancing is a way of showing compassion and care for oneself that can translate to more positive feelings about oneself. Actively engaging in self-care may, in turn, lead to a greater investment in protecting and nurturing their bodies. Cara insists women should ‘try to be the healthiest version of yourself’.

Positive rational acceptance, where a woman accepts the reality of ageing without judging herself or trying to fight it, can help women of midlife cope with media exposure that reinforces the thin ideal. ³⁷ Cash et al. found that women who used positive rational acceptance were less likely to define themselves by physical appearance and had greater body image, self-esteem and quality of life. ⁶⁵ Some participants in this study were utilising these strategies. For example, Cara talks about her body image, ‘At 55 years, I would say it’s really healthy. I’m very positive and I don’t go to extremes’. Another adaptive response displayed by some participants was body image flexibility, the ability to sit with and accept one’s body-related thoughts and feelings without trying to change or act on them. ⁶⁶ Body image flexibility has been identified as a component of positive body image, ⁶⁶ such that women high in body image flexibility can acknowledge aversive thoughts or feelings about their body, without the need to suppress or deflect. ⁶⁷ They are also able to resist increased body surveillance and preoccupation with outward appearance. ⁶¹ This finding aligns with the work of Tiggemann and McCourt, who found that body dissatisfaction and appreciation can be experienced simultaneously. ⁶⁰ Roxy shares that she thinks building resilient people helps. ‘I think that’s probably what my mum did, more concentrated on what you can do, not what you look like. And I guess that’s what I’ve tried to do with my girls, it’s what they can achieve’.

Positive self-reflection and gratitude, where women can focus on their strengths and be thankful for their bodies and what they do for them, ⁶⁸ was rarely expressed by participants. Only one participant, Rose, expressed sentiments of gratitude for her body, reporting, ‘It’s really empowering to be able to say look, my body can still do that at this age’. Considering its positive impact on body image, ⁶⁸ the lack of positive reflection and gratitude in women should be targeted. McCullough et al. suggest that orientation towards and greater awareness of positives can have psychological benefits such as happiness and life satisfaction. ⁶⁹ Self-care activities and cognitive strategies (i.e. positive rational impact, body image flexibility, positive reflection and gratitude) are well documented to improve body image; however, these strategies are often unknown to women or difficult to learn and utilise correctly. Researchers such as Tylka suggest that positive psychology programmes would likely support women ageing more optimistically. ⁶³ Given the numerous responsibilities that women in midlife typically juggle, self-guided online programmes may be most appropriate to increase their engagement and impact. This approach may be especially relevant for women with greater levels of normative discontent. ³⁷

Implications

The present study captured women’s lifelong body dissatisfaction and the associated burden on their lives. The results highlight the need for accessible and effective strategies to assist women in developing the skills to improve their body image for life. Grogan supports the need for effective interventions such as teaching media literacy and ways to reject idealised media images and instead embrace one’s own qualities. ¹⁰ Further, there is a need to promote positive body image in young girls and women who are dissatisfied or anxious about their bodies, thus improving health, wellbeing and body image. ¹⁰ Given the potential impacts of childhood experiences, consideration could also be given to early training or potential health promotion activities for young parents to learn how to break the cycle of family commentary and teasing. Targeting education around promoting positive body image and self-acceptance, in schools, health settings and antenatal classes, could elevate the understanding of the impacts that parents, especially mothers, can have on their children’s long-term body image. This could help women to become more literate in strategies to build positive body image, and to inoculate against society’s focus on thinness and weight. These skills could assist to manage the changes that occur during midlife, which will allow women to accept the natural ageing process and be confident in their skin at a time when change can exacerbate poor body image. ³⁷

While early intervention will reduce body dissatisfaction throughout the lifespan, programmes specifically addressing body dissatisfaction in women of midlife are essential to reverse the damage already done to their body image. For example, Tylka and Wood-Barcalow noted that feminist scholars argue that women should be able to accept that bodies can differ from the expected societal ideals. ⁶⁶ As a cohort, women should champion a culture that abhors body shaming and a body-hating discourse. However, this burden should not be solely placed on women and interventions should target society at large. Furthermore, an equal emphasis should be placed upon individual and social interventions, which will complement each other.

Limitations

A limitation of this study is the limited participant diversity. The women who participated were relatively homogenous in characteristics such as cultural background, education and socio-economic conditions. While the study provided a comprehensive exploration of body image in women of midlife, the body image of men was not explored. Future research would benefit from exploring the body image of women in later life and seeking more diversity in participants. Furthermore, longitudinal studies should be implemented to monitor the long-term impacts of suggested interventions.

Conclusions

Overall, the findings of this study have provided valuable insight into how women of midlife experience body image. For participants in this study, negative body image has persisted into midlife and ageing has exacerbated negative body image to an extent. This highlights the importance of researching effective methods of improving body image in girls and women of all ages. This research should aim to create champions of positive bodies, not just a society that merely tolerates their body or accepts a level of dissatisfaction. ⁶⁶ However, reducing negative body image on an individual level is not sufficient. The importance of self-worth, appreciation for the functionality of bodies, and the acceptance of diverse bodies must be promoted across society. This may allow for body dissatisfaction to coexist with body appreciation and respect. Given the improved wellbeing and quality of life that positive body image could bring to women, additional research in this area is vital, noting it is not a one-size-fits-all approach. ⁷⁰ While research is beginning to capture the components of poor body image, future research should expand upon these and aim to develop interventions that improve one’s body respect and body acceptance, while rejecting unachievable beauty standards.

Appendix

Appendix 1: semi-structured interview questions

1. Tell me a bit about yourself and why you decided to get involved in this study?

2. How do you feel about your current appearance and body shape?

3. Why do you think you feel that way?

4. What has influenced these views?

5. Can you talk me through how you have felt about your body through different stages of your life?

6. Are there any times that stand out?

7. Why do you think that is?

8. How do you feel your peers and others in society view you?

9. - Can you describe any particular experiences that influenced how you feel?

10. How important was/is this to you and has this changed throughout your life?

11. Can you talk to me about whether any people/information/or activity in your life influences how you feel about your body, whether that be in a positive or negative way?

12. For example, your partner, health screenings, going to the beach?

13. Can you talk me through anything that you feel has helped improve your body image or has helped you have a stronger body image?

14. If you find yourself feeling less positive about yourself or your body shape or body image, what sorts of things do you do to improve your positivity?

15. What would you like to be different now or in the past?

16. What are your thoughts on menopause? What is your experience?

17. What are the benefits of being this age?

18. Finally, what would you like to tell younger women/other women about their body image or being middle aged or ageing?