Toward the end of middle childhood, individuals experience increased awareness of body image, or how they think and feel about their bodies. A preoccupation with body image and size may be further exacerbated by school transitions and the simultaneous occurrence of puberty and associated social and academic pressures (Levine, Smolak, Moodey, Shuman, & Hessen, 1994). Research illustrates that body and weight dissatisfaction occurs as early as third grade; is greater in European American than in African American children, females than males, and those with a heterosexual orientation; and increases over time, peaking around eighth or ninth grade (Thompson, Rafiroiu, & Sargent, 2003). These patterns of body dissatisfaction also tend to occur in other affluent countries, such as Hong Kong, Australia, and Sweden (Lam et al., 2002; Lunner et al., 2000).
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