The eye-popping costs of appearance ideals

Yvie: [00:00:00] This podcast is recorded and produced on the land of the Wurundjeri people of the Kulin Nation. We pay our respects to their Elders, past and present, and extend that respect to all Aboriginal and Torres Strait Islander people who may be listening.

Yvie: Welcome To another episode of let’s talk a podcast from butterfly foundation. I’m your host Evie Jones. And in this episode, we’ll be discovering the hidden cost of body dissatisfaction and appearance based discrimination in Australia. We’ll be deep diving into the findings of a new groundbreaking report, appearance ideals.

Yvie: Commissioned by Butterfly Foundation. To help, I’ll be joined by Sarah Squire, head of knowledge, research, and policy at Butterfly Foundation. Elizabeth Clark, a partner and researcher from KPMG, who headed the report on Appearance Ideals. And lived experience advocate, [00:01:00] Evie Gardner, to uncover the true cost, both financial and personal.
Yvie: of this barely discussed societal problem. You’ll hear about the staggering statistics behind body image concerns, the economic and mental health toll they take, and the urgent need for policy changes to combat these issues. We’ll also discuss how we can reshape societal attitudes and create a more inclusive future for all body types.

Yvie: Sarah, I’m going to start with you because you’re from Butterfly Foundation. Please introduce yourself and what prompted Butterfly to commission this comprehensive research into Appearance Ideal.
Sarah: Yes. So hi everyone. Hello listeners and viewers. I’m Sarah Squire. I’m the head of knowledge, research and policy at Butterfly Foundation.

Sarah: And I was the project manager on this report. So I guess a bit of [00:02:00] background. So in this time last year, we actually released a report called paying the price, which was an analysis of the economic costs of eating disorders to the Australian economy. And that report was actually a repeat of the first report we did on that topic back in 2012.
Sarah: Now both of those reports have been heavily promoted and used by the media, by other people in the sector, by researchers and politicians. Um, cited a lot in Parliament, which is great. And really those findings have been used by people, including Butterfly, to advocate for more investment. in addressing eating disorders.

Sarah: And look, we knew those statistics were quite powerful, but we also knew they were really just the tip of the iceberg. A much bigger iceberg. And so in commissioning this report we really wanted to understand a bit more around what we’d call the key modifiable factor in the development of many eating disorders and that’s body dissatisfaction.

Sarah: I guess people mostly know of Butterfly through our provision of treatment and support services for people with eating [00:03:00] disorders, such as through our national helpline, but Butterfly has also been working in the prevention space for nearly two decades. And a lot of that work really focuses on trying to reduce body dissatisfaction.

Sarah: through campaigns and programs in schools, things like that. So we did know from other research that if we can improve people’s thoughts and feelings and beliefs about their bodies and other people’s bodies, then we can reduce the development of an impact of disordered eating and eating disorders. But I guess we didn’t have the hard numbers that we’ve now got in this report to kind of support that investment at scale.

Sarah: And the other area we’re very interested in, and it’s a personal interest of mine, is to really understand some facts around appearance based discrimination, because we knew from our long engagement with people with lived experience that this is actually quite widespread in the Australian community.

Sarah: And also Australian anti discrimination law is pretty limited in terms of the protection it offers from this form of discrimination. So There’s really very little recourse for anyone who’s treated unfairly because of how [00:04:00] they look, particularly when it comes to size and shape. So look, we really were just after some very good quantitative data on these things for us as an organization, but also for the broader sector and others.

Yvie: And that’s what I was going to ask next was some people might say who cares, but you’ve kind of answered that, like in just how incredibly important it is and you know, how many factors are involved in it, knowing that you work in the field of body image and eating disorders, what findings were expected by you?

Sarah: I guess I expected to see the numbers as high as they are for others, maybe. Those weren’t unexpected, but for me, I did expect that would be high. I knew there would be several mental and physical health impacts and costs. I also suspected there’d be gaps in the data about different types of appearance based discrimination, and that’s borne out in the report.

Sarah: And I knew from previous work in women’s policy and women’s health, that women and girls would be disproportionately affected, but in terms of. [00:05:00] Yeah, what surprised me? Yeah, I think the impacts on things such as smoking rates and various physical conditions. They were of great interest to me. I think the impacts on suicidality and self harm, really sobering to read, to see that in black and white in the report.

Sarah: The other standout, I guess, would be the finding that people who speak languages other than English in the home, people from LGBTQIA plus communities, and people born with a sex variation, Also experience higher rates of appearance based discrimination. So I think that really goes to the intersectional nature of experiences we have with our bodies and the different types of stigma that, um, people experience in the world.

Sarah: And yeah, finally, I said the other, the other thing was really of interest to me in the report was how much money. people are spending on making alterations to their appearance every month in terms of surgical procedures, but also cosmetic procedures. And my thoughts immediately went to, you know, who is benefiting from this growing [00:06:00] industry where millions of people.

Sarah: Are spending lots of money to try and stop feeling so bad about themselves. So yeah, there’s a lot, a lot in the report to digest and yeah, really, really recommend people have to take some time and have a deep dive into those findings.

Yvie: I’m going to bring in Elizabeth Clark now from KPMG. Elizabeth, if you’d just like to introduce yourself and tell us, what was your involvement in this report?
Elizabeth: Sure, thank you. So I’m an economist by background and work quite broadly across economic and social policy issues, focusing on evidence based analysis.

Elizabeth: Sarah and the Butterfly team engaged us to help really fill that gap in understanding regarding the prevalence of body dissatisfaction and weight based discrimination, and importantly to quantify the costs. associated with those things. So I was one of the leaders of a really [00:07:00] talented team. I can’t take credit for all of this.

Elizabeth: I have an amazing team that is quite multidisciplinary in terms of coming from clinical, economic and health policy backgrounds, which really kind of came together to design the research approach, undertake that really critical data collection and consultation and engagement, and then collate and analyse and interpret the findings.

Yvie: And can you describe the process for collecting the data? How many people were surveyed? How did you survey and what kind of questions were asked?

Elizabeth: We spent a lot of time up front planning the research to be undertaken and really developing quite a detailed framework to help. guide how we were going to go about doing primary information collection and the analysis.

Elizabeth: And critically, that plan was tested with independent experts and the lived experience working group, which was really, really critical. So the data collection focused on our four key research questions, which were really [00:08:00] around prevalence impacts and costs associated with body dissatisfaction and appearance based discrimination.

Elizabeth: We relied on a lot of. existing research and literature. We scanned thousands and thousands of papers and really drew together the findings of that literature to help design our research approach. We then brought together existing Australian Data resources, but then we do our own specific survey. So that included a sample of over 2000 individuals from the general Australian population.

Elizabeth: And that sample was really deliberately designed to ensure we were getting a reflection of. Australia as a whole. So from a kind of demographic point of view, it was representative. And then we surveyed a further kind of 400 or so individuals through the Butterfly Foundation channels, just to make sure we were getting some real insights from those who had experience or specific [00:09:00] knowledge of some of the challenges.

Elizabeth: So that was really the survey approach. In terms of the types of questions, it was quite broad. So we were keen to unpack people’s experiences. and score really their level of satisfaction with their own appearance, but that went into detail around the certain aspects of their appearance. So, you know, muscliness or thinness and their levels of satisfaction with those aspects of appearance.

Elizabeth: So we can understand what was driving the score. Then we went into kind of, uh, feelings about body and appearance and how that impacted them in terms of participation and engagement with life activities. So things like whether it impacted them entering a relationship or engaging socially or going to the beach or the pool, and then also looked into the impact of discrimination on their daily life, um, and whether they were accessing any supports.

Elizabeth: to help them [00:10:00] deal with those impacts. And as Sarah mentioned, we explored also things like spending. So spending on appearance related products and treatments and any conditions also that they might be experiencing relating to their appearance or their ideals.

Yvie: I’d like to bring in Evie now. Evie, please introduce yourself and tell us a bit about first your experience with body image and disordered eating.

Evie: Sure. Thanks, Evie. So I’m Evie, and I am a self described fat person, and I have lived experience of weight stigma and weight based discrimination. And because of those experiences have had situations and have developed issues around my relationship with food, so experiences of disordered eating, and issues around My body image and relationship with my body as well.

Evie: So [00:11:00] that’s sort of something that I’ve experienced since I was. It’s really quite young, pretty much as soon as I kind of developed an understanding of my body, developed an understanding of food and the different societal and cultural expectations around food and bodies. And so I was invited onto the lived experience advisory group for the report based on that experience, which really allowed me to bring that lived experience lens and just keep the report centred around.

Evie: These are numbers, but these are numbers that are actually affecting real life people at the end of the day. They’re not just costs and they’re not just numbers to kind of motivate politicians. These are real people that these costs are happening to. So really grateful to Butterfly and the KPMG team for establishing that lived experience group.

Yvie: And what did you learn through the process that you may not have known before?

Evie: I think similar to Sarah, there’s a lot that I already know through my personal experiences [00:12:00] and my professional experiences as well, working in eating disorders research and the public health sector. But I think. What’s really shocked me is just how much appearance based discrimination and appearance ideals are costing us financially and socially.

Evie: I’ve always been aware that those costs are happening because those costs happen to me, they happen to a range of people that I know. Um, you always hear stories about the social and mental health impacts of appearance based discrimination, but actually seeing those numbers down on paper and just seeing how big those costs are was really shocking.

Evie: Something that definitely shocked me and just reminded me of the importance of always being aware of, of these ideals and being aware of, of not just their financial costs, but their costs across different social situations and lost opportunities and just a range of different communities. social, economic, and cultural costs that these [00:13:00] ideals have on people.

Evie: So I think being part of this process and really getting to see how the KPMG team were estimating these costs and calculating that financial costs was, was something that was. new to me.

Yvie: Yeah. Well then I want to go over to both Sarah and Elizabeth, which of the results really stood out for both of you, Sarah, I’ll start with you.
Sarah: Yeah. Look, as I said, I think, um, yeah, as, as Evie says to the, the volume of the costs, the amount of money, I think the prevalence as well, you know, over 4 million people are experiencing this and that’s experiencing significant body dissatisfaction. That’s just not. You know, a little bit of body dissatisfaction, you know, clinically significant levels.

Sarah: And yeah, that the, the other 3 million in terms of appearance related discrimination, that’s a lot of people experiencing a lot of stigma and discrimination. For many that would, I imagine that’s on a daily basis, you know, and thinking about the compounding effect of [00:14:00] that on someone’s life, I think, yeah, really sobering to read, as I said before, those impacts on a whole range of mental health conditions, including anxiety, self harm, suicidality, but also physical health impacts as, as well.

Sarah: So I think, yeah, health costs. Um, impacts in terms of people’s avoidance of healthcare is a really big one. We’ve heard a lot from people who’ve lived experience about that during my time at Butterfly. So yeah, I think that’s something that might seem to perhaps to the average sort of reader or listener might not be seen as a big deal, but actually is a big deal if it stops you from going to the doctor when you’re sick, then this is a really huge issue with costs for the individual, but also costs for the healthcare system, you know, for, for public funding and also for private funding.

Yvie: Yeah, good points. Elizabeth, how about you?

Elizabeth: Yeah, I mean, echoing Sarah’s points that it was really just eye opening in terms of, I guess, the scale of the prevalence and the magnitude [00:15:00] of the impacts. You know, economists, I mentioned before the survey, you know, it was representative of the Australian population and, and what it found was You know, almost one in five people over 15 are dissatisfied with their body.

Elizabeth: I mean, that’s, that’s huge when you think about it in that way. I think, you know, the breadth as well, when we unpacked the impacts that really struck me. And, you know, they spanned from mental and physical health factors to social inclusion and quality of life. Some things that stood out to me, you know, as a, as a leader in a large employing organization, some of the findings around the impacts around engaging professionally and professional development and workforce engagement and discrimination in the workforce.

Elizabeth: That, that really stood out to me in my kind of professional capacity.
Yvie: It is quite shocking. To both Sarah and Evie, I’d like to ask, should governments and policy makers get involved in this? [00:16:00] And if so, how, Evie, what do you think?

Evie: I mean, this report highlights, as we’ve sort of all said, the pervasive nature that appearance ideals have on social and different financial costs and impacts as well.

Evie: And so I think. You know, being able to have the opportunity to share my story and my experience with appearance based discrimination and weight based discrimination in particular, I think is so important to remind politicians and government again, that the costs and the impacts are happening to so many Australians and.

Evie: You know, that, that the costs on me have been wide ranging from missing out on different social events, not going to pool parties because I didn’t want to be seen in a swimsuit, not being able to focus in class and at school because I’m too busy thinking about what I look like and [00:17:00] restricting my eating and those sorts of things as a result of this discrimination.

Evie: And so I think. If that’s just my one story, there are a myriad of other stories out there that are happening every day. And so it’s essential that government and that level of action is happening to address and prevent these impacts. So impacts across disordered eating, body image concerns, eating disorders.

Evie: We need government action and funding to actually prevent these from happening and supporting the people that these are already happening to. Otherwise These financial costs that this report is highlighting are just going to continue to affect Australia and the awful social and other costs to individuals are just going to keep happening.

Yvie: Sarah, same question to you, but also what message do you want to send to the various sectors of our society, including education, health and business sectors from someone at Butterfly Foundation.

Sarah: Oh, look, how long have you got Evie? We could be here [00:18:00] all afternoon and into the night if I really get on my high horse.

Sarah: So look, yes, absolutely echoing what Evie has said. This is something that governments and policymakers need to get involved in, but I think it is worth stepping out kind of the different roles that different players can have here. So I think, you know, a key one for us where we’ve been working for a long time at Butterfly is in primary and secondary school education.

Sarah: So I think in those. I think these findings, I hope, will mainstream the issue of body dissatisfaction and appearance based discrimination because they affect so many children and young people, and of course those children and young people grow up to be adults, you know, that might be struggling with these things for a long time, and hence the cost over a lifetime, as opposed to the costs in the report, which are just annual costs, would be, again, enormous.

Sarah: So, I would love to see more schools take up butterflies prevention programs, universal prevention programs. I’d love to see more mental health organizations and initiatives including body image considerations within their offerings as well. I think there’s a lot to do around school based education around nutrition and [00:19:00] physical activity.

Sarah: I think that really needs a shake up in terms of what’s in the curriculum, how things like healthy and unhealthy are framed, how food and eating and bodies are framed. For policy makers within government, I think we need a bit of a shake up of public health campaigns around physical health. I think, you know, particularly for people who campaign against obesity, I think need to have a bit of a rethink about some of the narratives they run and how they can play into people’s feelings about their bodies and the way people perceive bodies that are classed.

Sarah: Let’s say outside social norms. I mean, look, I’d really love to see the elimination of the body mass index as the be all and end all of health assessment. That’s probably a different podcast. So I won’t, won’t go on about that too long, but, um, I think we need, yeah, a really different holistic understanding of, of health and a person centered version of health.

Sarah: So I think the finance can kind of really help encourage those conversations, those changes. And as Lizzie was saying, I think for employers. There are impacts in terms of productivity at work, presenteeism, absenteeism, things [00:20:00] like that. And I think the message really is similar to other forms of difference in the workplace.

Sarah: So in terms of diversity and inclusion, I think employers need to think about, is appearance an area where they hold conscious or unconscious bias? And is that reflected in any of the systems in those workplaces? And if they are, I think they need to work to dismantle those. But absolutely, this is something that governments need to be involved in at that systems level. So essentially, I would say we need funding for a proper public health approach. You know, we need a kind of campaign like they’ve run for smoking and now vaping, right? Because those campaigns can really deliver some long term savings as well as eliminate, you know, the misery that’s So many people are feeling, as I’ve said earlier, I think I’d love to see some change to anti discrimination law to prescribe appearance based discrimination at a national level to actually give people an avenue to complain.

Sarah: If they’re experiencing discrimination in the workplace or accessing goods and services, I feel they need, um, you know, some recourse there. And [00:21:00] also I think the law has a very important symbolic value and what it says about the kind of society we want to be. So look. There are so many things that I think could happen, but for me, it’s that public health, it’s health policy, and it’s also about legal avenues for redress.

Yvie: I’m going to finish with asking Avey, our guest who has the lived experience, what message do you want to send the community about the tyranny of appearance ideals?

Evie: Same feeling as Sarah. There’s so much I think that we could say to people who are experiencing this discrimination and the impact of appearance ideals.

Evie: I think one thing that really sticks with me is remembering that if we’re talking about certain forms of discrimination, so my experience is in weight based discrimination. The culture and society that upholds those values [00:22:00] around what your body should look like, what you need to look like to be quote unquote healthy, that impacts all of us.

Evie: So no matter what size or shape you are, those ideals are kind of affecting everyone and how they relate to their bodies, how they relate to food. So I just sort of want to say that to anyone who is experiencing appearance based discrimination or is struggling with appearance ideals. I see you. I know how difficult it is.

Evie: And I just want to hopefully end on a, on a hopeful note as well, that although the report highlights, you know, this vast cost and, and social burden on people experiencing appearance based discrimination, I am really hopeful that we are going to continue progressing into a society where. We can challenge these ideals and respect everyone, no matter what their appearance is, no matter what their body size is, and just allow them to exist as, [00:23:00] as who they are.

Evie: And just the work that’s being done at Butterfly Foundation, at the National Eating Disorders Collaboration and a range of other organizations towards weight inclusivity and other forms of, of inclusivity as well. It just brings me so much hope that. As a society, we are, we are moving into a place where people don’t need to worry about what they look like and don’t need to worry that they’re going to wake up and, and have to face someone discriminating against them because of their appearance.

Yvie: Well said, and I second that myself, someone with lived experience. So I thank you very, very much, Evie. Sarah, Elizabeth, thank you all for coming on, for your time and for your generous answers. We really appreciate it. I think we’re going to get a lot out of this episode.

Sarah: Thank you so much. Thank you. Thanks for having us, Evie. Great discussion.

Yvie: A huge thank you [00:24:00] to Sarah, Elizabeth and Evie for sharing their knowledge, expertise and personal experience and helping us to understand this discrimination that so many Australians go through. If you’re concerned about an eating disorder for yourself or someone you care about, please reach out to Butterfly National Helpline at 1 800 334 6666.

Yvie: That’s 1 800 ED HOPE for a free, confidential conversation with one of our specialist counsellors. Alternatively, you can chat online by visiting butterfly. org. au. And following the prompts at the top of the page, you can also download your own support script to take to your GP or other healthcare professional, personalised with your needs and requirements for a better experience.

Yvie: To find out more about today’s episode, Check out the helpful links in the show notes and on Butterfly’s website. [00:25:00] Just head to butterfly. org. au forward slash podcast and click through to this episode. Let’s Talk is produced for Butterfly Foundation by Evie Jones and Sam Blacker from the podcast butler with the support of the Warratah Education Foundation.

Yvie: Our executive producer is Camilla Becket with support from Melissa Wilton and Kate Mulray.