How research can help tailor evidence-based interventions for underserved groups: Body image and ethnicity

28 Jan 2025

Body image and eating disorders are a pressing public health concern.  

Given this, in 2017, the UK government proposed to roll-out preventative interventions as part of the Children and Young People’s Green Paper.  

The paper established Mental Health Support Teams to work within educational settings such as schools and colleges. The teams would draw on evidence and provide guidance and support for young people’s mental health and well-being.

Among other things, the teams would deliver the most researched and developed intervention of its kind – ‘The Body Project’, group-based intervention with an evidence-base spanning 20 years.  

Yet since it originated in the US, it was thought that The Body Project might need some tailoring to make it implementable and impactful in UK settings.  

Queen Mary University London researcher Hannah Kate Lewis embarked upon an NIHR ARC North Thames-supported PhD project to evaluate The Body Project’s relevance to the UK’s second largest ethnic group: South Asian women and girls. 

Hannah's project gathered young women's and mental health professionals' perspectives on how body image presents in the South Asian group. She spoke with people from a South Asian background to hear their experiences and work collaboratively on modifications to the current programme. 

Together, they agreed what changes are needed to make The Body Project culturally appropriate for young women and girls in the South Asian community. These included:  

  1. a need to broaden the focus from challenging a ‘thin ideal’ to an ‘appearance ideal’ (to reflect the appearance pressures related to skin colour and tone, facial features and body hair);  
  2. more culturally appropriate prompts and examples throughout intervention activities; and  
  3. considerations around language choices.  

These insights have been shared with NHS Mental Health Support Teams across the country at their Community of Practice meeting so that this intervention can be rolled out for adolescent girls within schools in a more culturally inclusive way.  

Hannah is still working to feed these findings into shaping mental health and well-being support, including feeding into a parliamentary briefing based on mental health and well-being in schools. 

Having just passed her PhD viva with minor corrections, we spoke to Hannah to get a look behind the scenes at her research. 

Hannah presenting her research at an event

Pictured: Dr Hannah Kate Lewis presenting research at an event, with a presentation titled: 'Screaming into the void': How can we translate our body image research into policy impact to advance equality, diversity and inclusion in the UK?

First off, congratulations on passing your viva, Dr Lewis. It’s been a long journey to get here. How did this research interest first come about for you? 

There were really two main drivers for how this research came about.  

Firstly, I've always been interested in the prevention of body image disorders based on my own personal experiences, which developed whilst I was at school. That's why I was so keen to root my PhD in the policy context of government mandated prevention programmes in schools. 

Secondly, with a background in political science I've always had an interest in exploring inequalities – especially in healthcare. 

The field of eating disorders is really waking up to the damage of 'the eating disorder stereotype'. By this I mean: for so long, there has been a sampling bias in eating disorder and body image research.  

Consequently, our interventions are rooted in the experiences of White, cisgendered, heterosexual, able-bodied, teenage girls with a restrictive-type eating disorder. Yet that does not represent the full spectrum of experience of body image dissatisfaction and disordered eating. 

This means that when there is an evidence-based treatment that has been recommended by the government to be rolled out, we have to be mindful that it may not be suitable for everybody and be inclusive of everyone's needs. 

My research intended to be a step in the right direction of trying to address this. 

Sounds like a much-needed area of focus. What were some of the challenges and highlights of the research process? 

The main challenge was trying to complete a PhD during a global pandemic! I had to put my data collection on pause for 18 months, which majorly impacted my overall timelines and scope.  

It also meant that all my data collection had to be moved online. As a qualitative researcher, I really value the human connection that can be made between researchers and people with lived experience, so I had to quickly adapt my approach to ensure it was suitable for online delivery. 

Even so, being able to listen to the stories of these young women and girls was definitely a highlight.  

What’s more, working alongside our fabulous Peer Researcher Dhanisha Vora was crucial. Because, although I could empathise with the girls' experiences due to my own lived experience of body dissatisfaction and disordered eating, having Dhanisha by my side – who has a South Asian heritage herself – was a way to ensure we captured the cultural nuances of the girls' stories.  

Pictured below: Dr Hannah Kate Lewis presenting her research at an event.

Dr Hannah-Kate Lewis is shown presenting her research at an event

What are your hopes for the impact of this research? 

I really believe that there is scope for this PhD to be translated into real-world impact. I'm definitely not expecting everyone to read a 90,000 words thesis, and so I want to continue to collaborate with experts-by-experience to co-produce more innovative ways to disseminate these findings.  

Already, there has been some impact at two different levels.  

The research method in itself has illustrated a novel method for co-production and power-sharing all while maintaining robustness. Given the relatively high level of citations of the methods report (38 in the last two years), I’m hoping other researchers can follow suit in tailoring existing evidence-based interventions to be suitable for underserved groups. 

With regards to the findings themselves, having been engaged throughout, Mental Health Support Teams have therefore gained a greater awareness and understanding on how to tailor group-based body image interventions for South Asian girls. 

I'm also feeding into a parliamentary briefing based on mental health and wellbeing in schools, using the findings from the thesis.  

I’ve shared my thesis findings at medical trusts, to medical practitioners, students and psychologists, public policy and government fora, and – in collaboration with charities – to patients and the public. Because these findings are relevant to anyone working or living with those experiencing body dissatisfaction from this community. 

Long-term, I'm hoping we can produce a resource which can be shared with different audiences, for example:  

  • in GP practices and primary care services so that practitioners can 'spot the signs' of less obvious presentations 
  • intervention support resources for school-based practitioners to deliver the culturally adapted intervention in schools 
  • and community outreach resources to raise awareness and understanding of eating disorders and body image concerns in the South Asian community.

I'm also really pleased to have secured a two year postdoctoral fellowship funded by the NIHR Three Schools Prevention Programme. Here, I will be able to continue to collaborate with the South Asian community in East London and pilot and evaluate the adapted intervention in schools. I'm excited to continue building on my PhD findings and continue to find ways to prevent body dissatisfaction and disordered eating in schools in a more inclusive way.

Explore the project's methods report.

Learn more about the research.

If you’re interested in Hannah’s research and would like to get in touch, contact h.k.lewis[at]qmul.ac.uk.

Cover photo by Anna Shvets

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