Consumer opinion on social policy approaches to promoting positive body image: Airbrushed media images and disclaimer labels

Disclaimer labels on airbrushed media images have generated political attention and advocacy as a social policy approach to promoting positive body image. Experimental research suggests that labelling is ineffective and consumers’ viewpoints have been overlooked. A mixed-method study explored British consumers’ (N = 1555, aged 11–78 years) opinions on body image and social policy approaches. Thematic analysis indicated scepticism about the effectiveness of labelling images. Quantitatively, adults, although not adolescents, reported that labelling was unlikely to improve body image. Appearance diversity in media and reorienting social norms from appearance to function and health were perceived as effective strategies. Social policy and research implications are discussed.


Introduction
Governments, politicians, health professionals, researchers and advocacy groups have increasingly acknowledged poor body image as a public health issue requiring individualand macro-level intervention (Paxton, in press). Underpinning this stance is evidence that body dissatisfaction is prevalent in Western societies, affecting children, women and men across the lifespan (Bucchianeri et al., 2013;Jankowski et al., 2016). Furthermore, it is associated with increased risk of disordered eating (Stice, 2002), depression , self-harm (Muehlenkamp and Brausch, 2012) and alcohol misuse (Nelson et al., 2009). Alternatively, positive body image is associated with a range of beneficial health behaviours and outcomes, including increased physical activity, fruit and vegetable consumption and improved emotional health . Despite an increasing focus on social policy approaches to promoting positive body image, and that public support is often critical to their uptake and success (Puhl et al., 2014), consumer opinion on this type of intervention has largely been neglected. We address this gap by investigating consumers' opinions on labelling media images with airbrushing disclaimers, which is a commonly advocated social policy approach to addressing body image (Paxton, in press).

Influence of media on body image
The mass media have shaped and reinforced the current cultural appearance ideals, which emphasise thinness for women and leanness and muscularity for men, through an increasing over-representation of perfected images that do not reflect the majority of the general population (Spitzer et al., 1999;Sypeck et al., 2004). Idealised media images are routinely subjected to computer manipulation techniques, such as airbrushing (e.g. slimming thighs and increasing muscle tone). The resulting images present an unobtainable 'aesthetic perfection' that has no basis in biological reality.
Exposure to, and internalisation of, the current cultural appearance ideals portrayed in the mass media are robust predictors of short-term changes in body dissatisfaction (Shroff and Thompson, 2006;Tylka, 2011). Meta-analyses of experimental and correlational studies demonstrate that exposure to these manipulated media images results in negative body image and is a variable risk factor for the development of eating disorders (Barlett et al., 2008;Grabe et al., 2008). As a result, many body image interventions aim to deconstruct or change idealised and unrealistic media images.

Social policy approaches to promoting positive body image
In the United Kingdom, France, Spain, Canada, Israel and Australia, politicians and Government have been actively pursuing social policy initiatives to ameliorate the negative impact of idealised media images on body image. For example, in Canada in 2009, the voluntary Québec Charter for a Healthy and Diverse Body Image was launched to incite organisations and industries to promote a healthy body image (Gauvin and Steiger, 2012). In 2012, Israel introduced a law to ban the use of fashion models with a body mass index under 18.5. In 2013, body image was included in the Health and Physical Education curriculum for Year 10 students in Australia (Australian Curriculum, Assessment and Reporting Authority, 2013). Furthermore, 'Body Confidence Awards' supported by the Australian and British Governments have rewarded positive body image initiatives carried out by industry and community organisations since 2013 (Government Equalities Office, 2013).

Airbrushing disclaimer labels
One social policy strategy recommended by the British All Party Parliamentary Group on Body Image (2012), and lobbied by a number of advocacy groups (e.g. Girlguiding UK, 2010), is to label airbrushed media and advertising images with a disclaimer notifying consumers that the image has been digitally altered. Similar recommendations exist in a voluntary code of conduct developed for media and industry in Australia (Australian Government, 2009). Israel also passed a law in 2012 requiring airbrushed advertisements to display a clearly recognisable clarification of the 'graphical manipulation' used (Paxton, in press). Advocates argue that labelling airbrushed images with a disclaimer may reduce the negative effects of exposure to unrealistic media images on consumers' body image.
Labelling airbrushed media images putatively improves body image by raising consumers' awareness that the appearance of the individuals presented is not natural, and therefore is not a realistic target with which they should compare their own appearance to. Engaging in upward appearance comparisons with models and celebrities in media images has been consistently associated with increased body dissatisfaction (e.g. Tiggemann and McGill, 2004). Social Comparison Theory (Festinger, 1954) suggests that in the absence of objective standards, people will evaluate their own appearance by comparing themselves to others. Upward social comparisons occur when people compare their appearance to those they view as superior with regard to attractiveness, often models and celebrities. Theoretically, labelling airbrushed images with a disclaimer could disrupt the process of upward appearance comparisons, as the target would no longer be a relevant or credible target for comparison (Bury et al., 2014).
Disclaimers on media images and packaging have been employed as a health promotion intervention for a variety of health issues, including alcohol and tobacco consumption. For example, health warnings and product labels on tobacco packaging have been mandated in 77 countries (Canadian Cancer Society, 2014). Studies suggest that they have had some success in increasing health knowledge and risk perceptions about smoking and reducing smoking initiation (Hammond, 2011). This suggests that introducing disclaimer labels could also constitute a useful health promotion strategy to address poor body image. Nonetheless, despite recent lobbying to implement disclaimers on airbrushed images, empirical research indicates that disclaimers are unlikely to be effective in ameliorating consumers' body image concerns.
Several experimental studies have investigated the immediate impact of short-term exposure to appearance ideal media images with airbrushing disclaimers on body image, compared to those without disclaimers, among Australian and North American women in controlled experiments. Most studies have found that generic disclaimers (e.g. Warning: this image has been digitally altered), specific disclaimers (e.g. Warning: this image has been digitally altered to smooth skin tone and slim arms and legs) and retouch free labels (e.g. this image has not been digitally altered) have no short-term benefits for women's body image (Ata et al., 2013;Tiggemann et al., 2013Tiggemann et al., , 2014. Moreover, it is unlikely that these effects are due to women not attending to the labels, as an eye-tracking study confirmed that disclaimers are attended to (Bury et al., 2014). Furthermore, one study found that for women high in appearance comparison tendencies, exposure to specific airbrushed disclaimers that described a particular body part actually increased body dissatisfaction (Tiggemann et al., 2013). Another study also found that exposure to disclaimers increased the salience of negative thoughts (Selimbegovic and Chatard, 2015). In contrast, only one study has found benefits for body image associated with generic and specific disclaimer labels (Slater et al., 2012). Therefore, while airbrushing disclaimer labels may provide a useful awareness-raising tool and be easier to implement than removing perfected airbrushed images from the media entirely, the current experimental evidence does not suggest that they can prevent or reduce the negative impact of exposure to idealised media images on consumers' body image, at least in the short term.

Current study
Government officials, politicians, advocacy organisations and researchers have made their stance on airbrushing disclaimers and social policy approaches to improving body image heard. However, consumer opinion has largely been neglected. To date, only one study has investigated support for labelling airbrushed images among consumers, albeit in the context of social policy approaches to addressing eating disorders and weight stigma (Puhl et al., 2014). They found that 67.3 per cent of a representative sample of the US general public and 91.4 per cent of a sample of US eating disorder professionals supported this social policy action. It is both timely and necessary to introduce a more in-depth consumer perspective to this debate, as social policy approaches often rely on public support to justify the time and financial resources invested (Paxton, in press). Furthermore, it may help to explain the disconnect between policy recommendations for the use of disclaimer labels and empirical evidence for their effectiveness.
This study aimed to introduce a previously neglected consumer perspective to this debate. We conducted an exploratory online mixed-method study with British adolescents and adults to explore their opinions on (a) the impact of airbrushing on body image, (b) the impact of labelling airbrushed images with disclaimers on body image and (c) their preferences for social policy strategies to promote positive body image more generally. We recruited consumers across the lifespan, as consumers of all ages are exposed to idealised media images and are at risk of developing body dissatisfaction. Furthermore, previous research in this area has been largely restricted to samples of undergraduate women in North America and Australia.

Participants and procedure
A total of 1555 participants (57.45% female) aged between 11-78 years were recruited across England to take part in an online study titled Your Opinions on Media and Advertising. Institutional ethical approval was obtained prior to participant recruitment.
The sample included 525 adolescent girls (M = 13.65 years; SD = 1.47 years) and 271 adolescent boys (M = 13.31 years, SD = 1.33 years) aged 11-18 years from four schools in Bristol, London, Surrey and Lancashire. The majority identified as White British (78.6% girls; 84% boys). Active consent was obtained from schools and all adolescents, with parents/guardians of children under 16 years of age offered the opportunity to withdraw their children from the study. Adolescents completed the questionnaire in classrooms under the supervision of their teachers.
The sample also included 376 adult women aged 19-68 years (M = 34.90 years, SD = 10.42 years) and 383 men aged 18-78 years (M = 35.82 years, SD = 10.68 years). Adults were recruited from the Central London and Fylde Coast YMCA 1 email distribution lists (n = 464 YMCA members; n = 108 YMCA staff), and via YMCA England social networking websites (n = 187). Most adults identified as White British (76.8% women; 81.5% men). They completed the questionnaire unsupervised in their home or work setting and were entered into a prize draw to win an iPad on completion of the study.

Design and measures
We used a mixed-method questionnaire hosted securely online by Qualtrics. Two questions explored participants' opinions on airbrushing and airbrushing disclaimer labels: (1) What impact do you think airbrushing has on people's body image? (adult response options: negative/ positive/no impact; adolescent response options: bad/good/no impact) and (2) Do you think labelling airbrushed images with an airbrushing warning or notification would prevent any negative effects of airbrushing on people's body image and why? (response options: yes/ no). A free-text response box asked participants to explain their response choice following each item. Minor adjustments to these questions were made for adolescents to enhance readability. For example, the word extent was replaced with know how much and body image was defined as how people feel about the way they look.
The final question explored participants' opinions on social policy approaches to promoting positive body image more broadly (What other strategies do you think would be helpful to promote healthy body image and why?). Adults were provided with a free-text response box whereas adolescents were given a series of six strategies to rank in order of perceived helpfulness.

Data analysis
A total of 1533 of 1555 participants (n = 789 adolescents; n = 744 adults) answered one or more of the close-ended items. 2 Frequencies (%) were calculated for each response option by gender, separately for adults and adolescents. A total of 1401 participants (n = 676 adolescents; n = 725 adults) answered one or more of the three open-ended questions. These responses were subjected to thematic analysis within a social contextualist framework (Braun and Clarke, 2006). This involved interpreting and understanding the social context within which participant's thoughts, experiences and values were integrated (Braun and Clarke, 2012). In line with Braun and Clarke's (2006) guidelines, the first author (N.P.) familiarised herself with the data and then coded the data line by line across the question responses. Interesting excerpts were highlighted and notes were used to record extracts that were potentially relevant to the research questions. Codes that depicted similar ideas were collated to form themes that were reviewed, discussed and revised in collaboration with the second author (H.L.-S.) and third author (P.C.D.). Codes and themes were derived largely from the data. In addition, previous research and theories relating to body image, including Social Comparison Theory, were drawn upon to interpret participants' experiences. Due to the similarity of themes observed across the samples, the adolescent and adult data were combined for the thematic analysis.
Adults' preferences for strategies to improve body image are reported in Theme 3 below. With regard to adolescents' rankings of the most helpful strategies to promote positive body image, boys tended to favour strategies to be implemented in schools (e.g. learning about body image), while girls prioritised methods that targeted broader societal and macro-level change (i.e. to see people with different shapes and sizes in the media). Labelling airbrushed media images was rated as the second most helpful strategy by girls and the joint fourth most helpful strategy by boys. Adolescents' rankings (1-6, where 1 is most helpful) of the six strategies split by gender were as follows: (a) to see people with different body shapes, sizes and appearance in the media (girls: 1, boys: 4); (b) to label airbrushed images in the media (girls: 2, boys: 4); (c) to learn about body image in schools (girls: 3, boys: 1); (d) to provide more support services in schools for young people with body image concerns (girls: 4, boys: 3); (e) to make healthy eating a priority in school (girls: 5, boys: 5) and (f) to learn about the importance of exercise and sport in schools (girls: 6, boys: 2).

Qualitative results
Thematic analysis identified three main themes across the open-ended items for both adults and adolescents.
Theme 1: the impact of falling short. The majority of participants believed that exposure to idealised airbrushed media images has a negative impact on consumers' physical and psychological health, including body image. They said some consumers engage in health compromising behaviours, such as excessive exercising, restricting food intake and undergoing cosmetic surgery, in order to achieve the airbrushed look. Some made a direct link between exposure to airbrushed images and mental health problems (e.g. eating disorders, depression and low self-esteem): It makes young people want to be like them and drives them to extreme measures to dramatically change the way their body looks, it can make them hate their own looks, become depressed and lead to extremely bad health. (Girl,15 years) Airbrushed models create falsified images that people aspire to, making that mental image they wish for themselves to be nigh on impossible, hence they resort to drastic measures like surgery to improve their perceived looks. (Man, 33 years) It makes people stop eating or become an exercise fanatic to try and achieve an unachievable body. (Girl,16 years) Adolescent girls in particular also reported that airbrushed images have a negative impact on their own body image and self-esteem. They described themselves as feeling disgusting, fat and embarrassed following exposure to airbrushed images: It makes me feel bad about myself and even ugly sometimes. (Girl, 15 years) It makes you ashamed and embarrassed about your body. (Girl, age not reported) Because we see people with perfect skin and who are slim and we want to be like them it affects our self-esteem and makes me feel bad about how I look. (Girl,14 years) The negative impact of airbrushed images was largely attributed to their portrayal of an unrealistic standard of beauty. Specifically, participants believed that airbrushed images represent how people are expected to look, despite the fact that this appearance is not attainable naturally. In addition, some participants suggested that norms of attractiveness portrayed in the media are closely associated with desirable lifestyle and personality traits: … an artificial image of the human body is portrayed as the norm. (Man, 23 years) It is impossible to avoid internalising these as a benchmark for what is normal. (Woman,39 years) In order to be 'successful' and 'popular' and 'beautiful', that is the image we are expected to identify with, in an aspirational manner. (Man,45 years) This level of beauty is associated with material wealth and unachievable status. (Woman, 23 years) Participants frequently reported that they think consumers compare themselves to airbrushed images. In line with Social Comparison Theory and research that has applied it to body image (e.g. Tiggemann and McGill, 2004), the majority of participants believed that this comparison process leads to negative consequences when people realise their own appearance falls short of the unrealistic ideal portrayed in the image. They saw this comparison process as a mechanism for the negative impact of airbrushed images on body image: Because you cannot help but to compare yourself with the images that are portrayed by the media, 'She looks about my age but my skin has so many more lines and blemishes'… that kind of thing. 'She looks thin. I wonder if my legs are double the size of hers'… (Woman, 30 years) Those who compare their appearance/performance to models will take the image for 'normal' and will aspire to be the same -in case of failure of this attempt this can have negative consequences on self-esteem etc. (Man, 35 years) People compare themselves and they could think that they are fat and may come bulimic. (Boy,15) Yet, there was a minority of participants who argued that comparing themselves to airbrushed images gave them the motivation to 'look good' and a goal to pursue. They argued people can be 'inspired by perfect bodies' (man, age not reported) and 'airbrushing extenuates this perfection and gives me the drive to achieve it' (man, 28 years). As a consequence, some consumers believed these images can have a positive, aspirational impact on consumers' body image and their health more broadly: [seeing airbrushed models] has a positive effect on my physical appearance as it gives me a goal to aim for. Whether the model's body image is unachievable or not, it will motivate me to exercise and eat healthily. (Man, 25 years) …because looking at their bodies, that are airbrushed, you see what they look like, and you have determination to look like that. You drive to lose weight, and exercise etc., so you gain a positive body image of yourself, and airbrushed models help you achieve that. (Girl,14 years) Theme 2: to label or not to label? Participants discussed benefits and limitations associated with airbrushing disclaimer labels. Some participants believed that a label would be effective in notifying consumers that the image has been airbrushed. In turn, this was seen to have a number of benefits, including a reminder to consumers that the image is fake and untruthful; and that the model is ordinary and likely to suffer from imperfections too. These participants suggested that a 'reminder' would reduce the pressure felt by consumers to look like airbrushed models. They suggested that this could potentially disrupt the comparison process and consequently help them feel more positive about their appearance: Sometimes people forget that the images they see are airbrushed and photoshopped, but it would be good to have a reminder so they don't jeopardise themselves and their futures just to look like something that is impossible to look like. (Girl,16 years) In a small way it would help to make the point that these are not 'real' people so we should not compare ourselves with them. If this warning appeared often enough, the message might eventually sink in. (Woman,53 years) However, some participants pointed out that despite a disclaimer, the extent to which the image has been airbrushed would remain unknown. Consequently, consumers would not understand the degree to which the images have been airbrushed, suggesting that a label is insufficient. Participants argued that a label would be redundant without a 'before' picture: I think it reminds you of the fact that it has been airbrushed but you have no idea to what extent and how much has been changed. (Woman,27 years) Some participants also emphasised the notion of see, not read. They suggested that the visual impact of an image transcends warning labels, and consequently, people often do not register or adjust their thinking due to warning labels: People eat with their eyes, the damage is done before they get to reading the health warning. (Man,42 years) Disclosing it is superficial and pointless, people rarely look at warnings. An image is far more powerful than a few words of small print. Most adverts are taken in with a glance, the warning won't register. (Man,26 years) Relatedly, some participants also suggested that the emotional reaction to airbrushed images, regardless of labelling, is not necessarily rational and can often happen automatically: I think most impressions of images are probably sub-conscious. (Man, 34 years) The image will still register even if subliminally. (Woman,46 years) Finally, participants said that despite a warning label, the fundamental message remains; you need to look perfect, or look like the model in the image to be considered beautiful: Because the image would still be depicted as an ideal that we should try to attain. I think a label would certainly help people be aware that the images they are seeing are not real, but while the models are still depicted as ideal 'beauty' we will still feel bad about ourselves for not looking like them. (Woman, 30 years) The picture still looks too perfect, even with a label you are still compelled to try to make yourself look like that. (Girl,14 years) Theme 3: strategies to promote positive body image. Adult participants described a range of social policy approaches to promote positive body image, including the use of diverse appearances in the media, and increasing people's focus on the body's function rather than its aesthetic value. Interestingly, the strategies spontaneously suggested by adults mimicked some of the strategies that were provided for adolescents to rank in order of most helpful for promoting positive body image.
Diversifying the 'norm'. Adults said they want to see varied body shapes and sizes, ages, ethnicities and a wider range of physical appearances on the television, in magazines, on catwalks, and in advertising. It was argued that greater diversity of appearance in the media would better reflect the reality of society and avoid setting a narrow definition of beauty. This would consequently alter the unhealthy notion of what is currently perceived to be attractive and physically 'perfect': Simply to have more variety in body shapes so that people see themselves as falling within an 'acceptable' range rather than always falling short of the ideal (whether 'perfected by airbrushing or just near-perfect'). (Man, 46 years) Even though a lot of marketing ticks all the boxes when it comes to disabilities, gender, ethnicity etc., too many of the women/models are all the same size. (Woman, 26 years) Function versus appearance. Participants emphasised the importance of the promotion of physical health rather than physical perfection (woman, age not reported) by focusing on the body's functionality rather than its appearance. Many participants felt that emphasis should be placed on the benefits of a long-term 'healthy lifestyle' such as eating healthy foods and exercising, as opposed to a 'quick fix' (e.g. diets and slimming pills), which are commonly advertised in the media. Although they did not suggest ways in which this reorientation from focusing on appearance to health and function could be achieved in a tangible strategy or activity (e.g. encouraging physical activity in schools, health promotion campaigns), participants argued that this shift in thinking would help improve consumers' body image: Increase body awareness so people understand what their body is capable of doing-they will then see their body as a living part of them and not simply a 'shell' they exist within. (Woman, age not reported) People should be concerned with being healthy, exercising because it's good for the body and mind, not because they want to have what someone else has i.e. a body like Brad Pitt or Paris Hilton. (Man, 24 years)

Discussion
The aim of this study was to provide a previously neglected consumer perspective on social policy approaches to promoting positive body image, with a particular focus on airbrushing. We collected mixed-method data to explore the impact of airbrushing and labelling airbrushed media images on body image and consumer preferences for body image-related social policy approaches more broadly. Overall, participants reported that airbrushing has a negative impact on body image and many were not confident about the effectiveness of labelling airbrushed media images with disclaimers. Specifically, the majority of adults reported quantitatively and qualitatively that labelling is unlikely to improve body image. Furthermore, although the majority of adolescents reported quantitatively that disclaimers would be helpful to improve body image and adolescent girls ranked disclaimers as the second most helpful strategy for promoting a healthy body image, qualitatively girls and boys also voiced some scepticism about the effectiveness of labelling. Adults suggested that increasing appearance diversity in media images and reorienting social norms to focus on function and health, rather than appearance, would be useful social policy approaches to promoting positive body image.
The majority of consumers reported that airbrushed media images have a negative impact on people's body image. Qualitatively, they argued that airbrushing creates and promotes an unrealistic standard of beauty, which consumers will counter-productively compare themselves to and internalise. This is consistent with empirical research, which has demonstrated the harmful effects of exposure to airbrushed media beauty ideals on body image, and the mediating processes of making appearance comparisons and internalising cultural beauty ideals (Barlett et al., 2008;Grabe et al., 2008;Thompson et al., 1999). Interestingly, a minority of participants disagreed and reported that airbrushed images could have a positive impact on body image by providing an appearance standard to aspire to and consequently increasing motivation to engage in health behaviours (e.g. exercising, eating 'healthily'), in order to move them closer to the ideal appearance. A small number of experimental studies (e.g. Halliwell and Dittmar, 2005) have observed that if consumers are primed to view idealised media through the lens of self-improvement rather than self-evaluation, negative exposure effects can be buffered. As these researchers have argued, however, it may be that this buffering effect is short term and that negative exposure effects will ensue as individuals fail to reach the ideal depicted. This is particularly likely to be the case for airbrushed images that do not exist in biological reality and are therefore unachievable. Nonetheless, the finding that some consumers believe airbrushed images are motivational provides an interesting and novel perspective worth exploring in future research.
The perceived effectiveness of labelling airbrushed media images to promote positive body image was somewhat mixed, with adolescents reporting quantitatively that they thought it would be an effective strategy, while adults disagreed and some adolescents voiced scepticism in their qualitative responses. This variation in opinion between adults and adolescents could be related to differences in knowledge and experience of media. It could be due to the fact that adolescent girls today may have a greater appreciation of the role of media images in their own self-assessment of their bodies. Disclaimer labels may therefore be effective among adolescents but not among adults. Adolescents may be aware that they could learn over time to view images differently. Indeed, experimental studies have not looked at the cumulative effect of general disclaimers in increasing awareness of the falseness of images. Furthermore, to date there have been no experimental studies of the effectiveness of airbrushing labelling among adolescents. This presents an important area for further research given this study's findings among adolescents.
Qualitatively, both adults and adolescents acknowledged that disclaimers could raise awareness by reminding consumers that the image is fake. However, the majority of participants raised a number of limitations associated with labelling as a social policy approach to promoting positive body image. These may help to explain experimental findings of ineffectiveness, which have been counter to advocates' assumptions about the benefits of labelling (Ata et al., 2013;Slater et al., 2012;Tiggemann et al., 2013Tiggemann et al., , 2014. Participants thought labels are likely to be disregarded, not noticed, and unable to provide sufficient information to be effective. Many also believed that labels would make no difference to the way people feel about their own appearance, as they are still exposed to the harmful image. Indeed, the continued use of airbrushed models in media images was seen to reinforce the fundamental message that the portrayed appearance is ideal and desired, regardless of a disclaimer label. Collectively, our results and the results of recent experimental studies suggest that while it is encouraging that individual-level approaches to addressing body image are also being supplemented with macro-level intervention, airbrushing disclaimer labels are likely to be insufficient to address the negative impacts of exposure to unrealistic appearance ideals in media images. Indeed, the majority of adults and adolescent girls in this study indicated that showcasing greater diversity of appearance in the media would be a more effective strategy to broaden appearance ideals and improve body image. Experimental research has also consistently confirmed the benefits of using more average-sized models in media images for body image (e.g. Diedrichs and Lee, 2011). Findings also demonstrate that more representatively sized models are perceived by consumers to be effective in advertisements. Despite this, however, widespread change and increased diversity in media remain lacking.
Adult participants also emphasised the need to reorient social norms around bodies to focus on their functionality and health as opposed to their aesthetic value. Adolescent boys also supported this by indicating that learning about sports and exercise would be one of the most helpful strategies to promote positive body image in their opinion. Fortunately, coinciding with campaigning around promoting positive body image, governments, advocacy groups and researchers have also been dedicating their efforts towards reducing the objectifying nature of idealised media images and focusing on health, as opposed to appearance (e.g. Sport England's (2015) This Girl Can physical activity campaign). Further research is needed to understand the impact and acceptability of these efforts.
This study has addressed an important gap in research surrounding social policy recommendations for promoting positive body image by providing a previously neglected consumer perspective. The mixed-method data and community sample of adolescents and adults have provided a more in-depth and inclusive analysis to complement existing experimental research on airbrushing, which has largely been conducted with undergraduate women. However, while our online questionnaire methodology allowed us to collect a breadth of opinions from participants across England, it produced responses that were somewhat limited in depth compared to what could have been obtained from interviews and focus groups. Notably, our convenience sample of adults from YMCA staff and membership groups also means that our participants are more likely to have been focused on, and invested in, exercise and health than a more representative sample. As a result, there is a continuing need for more research investigating social policy approaches to body image, to not only assess consumer support which is often critical to the success of these strategies but also survey the opinions of a broader range of consumers.

Conclusion
This study offers new insight into consumers' opinions regarding the impact of airbrushing, disclaimer labels and social policy strategies to promoting positive body image more broadly. Qualitatively, both adults and adolescents were sceptical about the effectiveness of labelling, although quantitative differences in adolescent and adult views about the impact disclaimer labels would have on body image were noted. Overall, consumers believe that the presence of a disclaimer will not prevent the negative impact of exposure to idealised media images, which continue to be airbrushed and dictate 'aesthetic perfection'. While this practice remains, it is likely that consumers will continue to internalise and compare themselves to unachievable ideals regardless of a disclaimer label. Importantly, although there is clearly consumer support for macro-level interventions to promote positive body image, further research and consumer consultation is needed to understand what the most effective and accepted strategies to achieve this goal are. Our research suggests that including greater diversity of appearances in media images and focusing on functionality and health rather than aesthetics are useful avenues for the development of macro-level interventions to promote positive body image. Notes 1. The YMCA was founded in 1844 as a Christian charity for young men. Since the 1960s, the YMCA has broadened its focus to include young women and men, regardless of faith, culture or background. In the UK, the YMCA is the largest voluntary provider of physical activity programmes and services that promote healthy communities, in addition to providing accommodation and support to young people and their families. 2. A response was registered each time the first screen of the online survey was viewed, which only included information about the study to allow for informed consent. Exiting the study involved closing the Internet browser window at any stage of the survey. It was expected that some participants would exit the survey before completing a meaningful proportion of it.