Body norms – socially constructed ideas about how bodies can and should look – are powerful cultural phenomena with important health impacts. Concerns around failing to meet social expectations of thinness are associated with multitudinous health-relevant behaviors, such as how people eat, exercise, seek health care, or elect surgery (e.g., Flint, 2015; Puhl and Suh, 2015; Vartanian and Novak, 2011). Failures to meet what are perceived as acceptable body standards can also act as a psychosocial stressor, underpinning such negative individual health-relevant outcomes as low self-esteem and self-efficacy, eating disorders, and depression (e.g., Sikorski et al., 2015; Hackman et al., 2016; Tomiyama et al., 2018; Tomiyama, 2019). These probably also pattern to population-level variation and thus link to emergent health disparities (Hatzenbuehler et al., 2013).
Based on analyses of comparative survey data, anti-weight sentiments are suggested to be widespread, and thin-idealism also now dominates in advanced economies (e.g., Puhl et al., 2015; Brewis et al., 2011; Marini et al., 2013). Yet, for the most part, the basis of these recent changes in body dissatisfaction are only roughly observed, mostly in anthropologists’ ethnographic perceptions of what best explains shifts in norms at the community level. On the basis of these fragmented observations, anthropologists have developed two relevant explanations -- not necessarily discrete -- of what happened to global body norms since around 2000. Increasing media exposures, especially social media, appears to be one exogenous force that anthropologists consistently report as likely important to spurring shifts in cultural norms of thin-preference. This observation began with Becker’s (2004) study of the effects of the introduction of television on body norms in young Fijian women, but likely has been particularly accelerated by social media (see Anderson-Fye and Brewis, 2017). More recent studies include observations in Dominica in which much more strongly negative views of large bodies seemed to follow the adoption of Facebook in particular (Council and Placek, 2014).
Another set of propositions relates to a key role for shifting labor (and perhaps marriage: Hruschka and Han, 2017) markets, and particularly the role of the body in creating opportunities for social and economic advancement. The notion of “thin body capital” (Anderson-Fye and Brewis, 2017) is central here. Specifically, the idea that people will adopt and internalize body norms toward thinness when they provide feasible pathways to enhanced social and economic success. In many cases, the assumption is, women stand to benefit relatively more from the social and economic advantages of meeting body norms because they begin with fewer opportunities than men. They are accordingly more likely to adopt and work to meet stringent ideals. The idea that fat-negativity is driven by the recognition of the role of body capital in the cash economy is based in such studies as Anderson-Fye’s (2004) explanations of thin-idealism in the context of increased engagement in a tourism-driven cash economy in Belize, and Edmond’s (2010) accounts of how women pathway out of poverty by working to attain body-perfection ideals in Brazil.
Yet, beyond these necessarily localized ethnographic interpretations, little scholarship has documented the population-level tempo, scope, and dimensions of these important social changes around how bodies become unacceptable to the person themselves. Here we use a demographic approach and nationally representative data to untangle age, period, and cohort effects in changes in large-body dissatisfaction, using the case of South Korea from 2001-2017. Through this analysis, we can simultaneously test for potential roles for these theorized periodic-cohort factors linked to large-body dissatisfaction – specifically economic up-and-downturns and increasing internet exposure – while also considering such factors as aging and cohort effects, and individual level factors such as gender and socioeconomic status.
South Korea is an extreme case for considering how body norms change, with some attendant analytic advantages. Among the advanced economies, it has one of the lowest levels of obesity (Devaux et al., 2017). In 2016, 6.0% of Korean men and 5.1% of Korean women were categorized as clinically obese (BMI≥30kg/m2). For comparison, 38.3% of men and 41.6% of women in the U.S. in the same year and 31.5% of men and 29.3% of women in Australia in 2017 were estimated to be clinically obese in the same year (data available at http://stats.oecd.org). Yet, despite the extremely low population levels of obesity – or perhaps even because of it – anti-fat sentiment is reportedly now rampant in South Korea (Marini et al., 2013; Brewis et al., 2017; Noh et al., 2018). It is common to notice disparaging treatment of people with obesity in Korean media (Lim and Kim, 2012). In everyday conversations, more recent studies suggest that people often make judgmental remarks about people who are overweight (Kim, 2014; Schwekendiek et al., 2013). Indeed, managing appearance is one of the most common reasons that Korean men and women report trying to lose weight (Son et al., 2018). Previous studies also confirm an ongoing very high level of disordered eating, body dissatisfaction, dieting, and body modification through surgery among South Koreans (Pike et al., 2014; Han, 2003; Jung and Lee, 2009). While some societies may display cultural ambivalence around large bodies, allowing people to navigate between positive and negative notions of larger bodies (e.g., Hardin et al., 2018; Council, 2015), this is not apparently the case in South Korea (Marini et al., 2013).
More generally, the importance of physical appearance and body size in contemporary Korean society cannot be overstated. Giving attention to self-appearance seems to be linked to a highly competitive educational, career, and social market that rewards those who are perceived as beautiful or handsome; this phenomenon is also known as ‘lookism’ (Marini et al., 2013; Noh et al., 2018). Additionally, Korea has a well-documented stratified society that includes ranked educational institutions and companies; that is, in Korea it is not just about going to university, it is also about going to a top-rated highly selective university which may help an individual find placement in a prestigious workplace (Lee and Brinton, 1996), a phenomenon which is known to have negative effects on men’s body image and mental health (Garrison et al., 2018).
Although such data was not collected before 2000, the widespread use of the phrase “Mom jjang” (몸짱; Korean for “perfect body” or “body king”) syndrome --widely used and promoted by the mass media (Bissell and Chung, 2009; Park, 2007) – is suggestive of its potential influence on shaping changing body norms over time. Furthermore, the popularity of “PC rooms” (precursors to the Internet Café) on every street corner of urban and rural South Korea made access to the internet easy from the mid 1990s. These “PC rooms” boasted all forms of entertainment from internet surfing to computer gaming; this frequent and easy exposure to digital social media boosted the emphasis on appearance as exemplified by eoljjang (얼짱; “face king” syndrome, a person with a handsome or pretty face) (Park, 2007). A face without cosmetic makeup (쌩얼; saengeol), a young looking face (동안; dongan), and long legs (롱다리; longdari) received a lot of attention from the media and the public afterward throughout the 2000s (Park, 2007). Indeed, research among Korean adolescents (ages 17-19) has shown that social media content which emphasizes thinness and physical attractiveness strengthens obesity stigma (Lim and An, 2018). A qualitative study in the U.S. suggests that the same perhaps holds for adults and negative body image there (Paquette and Kim, 2004).
Body Dissatisfaction: Separating Age, Period, and Cohort (APC) Effects in the Korean Case
There are three potential demographic processes that we consider as we test possible theories as why body dissatisfaction might change (increase) over time at the population level: age, period, and cohort effects. While we discuss these potential effects in relation to South Korea in this section, many of the observations are also generalizable to other cases of advanced economies.
Age Effects: At the individual level, aging can play a role in changing body satisfaction over time. At least based on studies in the US, women appear to become more body-accepting as they get older. Thus, body dissatisfaction reduces (Park et al., 2019, Tiggemann and Lynch, 2001; Stevens and Tiggemann, 1998; Lamb et al., 1993; Grogan, 1999, McCabe and Ricciardelli, 2004). To our knowledge, there are no studies disentangling if this is because women’s body norms themselves change also with aging, other than what would be accounted for by period and cohort effects. But if aging matters for individual body (dis)satisfaction, then this could be reflected at the population level as well if the population itself is aging (as is the case in South Korea and many other advanced economies with low birth rates, e.g., Japan, Germany, and Finland).
Period effects: Period effects refer to factors driving exogenous change that happens in a fixed time period, such as the adoption of new technologies or sudden economic upheavals. In terms of body norms, media in general is presumed to provide a common source of new ideas about body image, and for reinforcing or strengthening them (Tiggemann, 2014; Han, 2003; Schwekendiek et al., 2013). In the period 2001-2017, as was the case elsewhere, South Korean internet usage increased dramatically. According to the Survey on the Internet Usage, the proportion of South Korean households that had access to the Internet nearly doubled between 2000 and 2016 (44.7% in 2000 and 88.3% in 2016).
In addition to media exposure, we identify shifting national job insecurity as another exogenous factor that may create South Korean period effects in body image dissatisfaction between 2001 and 2017. The neoliberal reconstruction of the labor market in South Korea started in the 1980s due to the pressure from other counties, but in particular pressure from the U.S. due to the trade surplus. In the late 1990s through to the early 2000s, the economic restructuring was accelerated due to the so-called “IMF crisis” (Shin, 2013; Lee, 2011). The government created a more flexible labor market followed by large scale layoffs, leading to significantly lower job security for most people. The study by Offer et al. (2010) based on the theory of welfare regime (Esping-Anderson, 1990) found that employment security is a strong predictor of obesity particularly in a liberal market setting. They argue that this association is likely due to differentiated bargaining power of individuals in the labor market. Under the liberal labor market with unlimited competition, human capital would play an important role in bargaining power at the individual level. Since there are many candidates with similar skills and education, appearance, as a form of human capital, is likely to gain substantial bargaining power in the labor market. This might have led to more Koreans, both men and women, paying extra attention to their bodies, resulting in a worsening negative body image at the population level. Taking these societal phenomena into consideration, secular changes (or period effects) in South Korea could lie at the root of more people perceiving themselves as “too fat” or otherwise dissatisfied with their body size/weight.
Cohort effects: Cohort effects are embedded in the shared and distinct experiences of people similarly exposed to a phenomenon – such as people born or entering college in the same year – so that period effects influence people at different ages disproportionally. Specifically, in the 1990s and 2000s, rates of Internet usage and the importance of appearance in the Internet world were the highest particularly among younger generations rather than older generations of South Koreans. The earliest and most enthusiastic social media adopters were those in their teens and twenties, i.e., “generation Z” born in the period of widespread internet (between mid-1990s and early 2000s). In terms of job opportunities and insecurity, those cohorts who are attempting to enter job markets during downturns should be more impacted by them. The cohort most affected by the Korean recession of 2008 would have been graduating from college and entering the job market for the first time (i.e., “IMF generation” born in the middle of the 1990s).
Individual Level Factors to Consider: We begin with the assumption that individual-level factors of gender and socioeconomic status (SES) should moderate aging, period, and cohort effects on changes in large-body dissatisfaction over time. For example, a high income grants more financial resources to invest in one’s body, or at least increase the chances of being around other people that do – thereby perhaps worsening one own’s body dissatisfaction. On the other hand, having more education may increase exposure to greater recognition of and resistance to unrealistic body norms. In a study of breast cancer patients in South Korea, for example, it was found that employed patients had higher levels of body image distress compared to patients who were unemployed (Chang et al., 2014). However, patients who had higher income reported better body image than those with a lower income (less than $3000/month). They also found that SES (as measured through marital status, education, employment status, and income) was significantly associated with “altered appearance distress, body image, and quality of life” (Chang et al., 2014). Women that were employed or socially active had “significantly higher distress from altered appearance and worse body image compared to housewives or retired people who were relatively socially inactive” (Chang et al., 2014: 8610). Finally, in another study aimed at adolescents, Park et al. (2018) found that a lower SES was associated with higher levels of reported problems with physical appearance especially among South Korean female high school students. While these studies do not replicate the population under consideration here, they show very clearly the importance of taking SES into consideration for issues of body image.
Exactly how gender should matter to temporal increases in large-body dissatisfaction is not clear for South Korea. Certainly, a range of studies have shown that Korean women can present very high rates of body dissatisfaction and other body image concerns (Lee et al., 1998; Ryu et al., 2003; Kim and Kim, 2001). Some prior research suggests that male body ideals in South Korea might in some contexts be even more stringent than female ideals, in that women must be slim but men must be neither too heavy nor too thin (Son et al., 2018). Also, qualitative studies demonstrate that South Korean men –especially younger men – are particularly susceptible to constant (and often unattainable) familial pressures to excel in their careers (Lee and Brinton, 1996; Garrison et al., 2018; Chin and Kim, 2016; Je and Shim, 2015), and good looks are often assumed by workers to be central to their ability to advance professionally (Lee, 2008; Hamermesh, 2013; Chae, 2019). Chae (2019) found that employed Korean people accepted “lookism” and engaged in behavior which maintained it. Thus the general cross-cultural observations discussed above, whereby women are likely more susceptible to large-body dissatisfaction period effects (like social media exposure or economic downturns), or that women place more importance on the benefits of “body capital,” cannot be assumed to necessarily hold in this specific country case.
