Introduction

Body image relates to an individual’s perceptions, feelings, and thoughts about their body and appearance (Grogan, 2010). Based on self-evaluation, one can either be dissatisfied with one’s looks to experience a negative body image or love, appreciate, respect, and accept one’s body to experience a positive body image (Tiggemann, 2015). Alarmingly, a significant proportion of adolescents are currently discontented with their appearance, making negative body image a pervasive global public health issue within this demographic (Rodgers et al., 2023). Negative body image is associated with numerous adverse health outcomes, including depressive symptoms and disordered eating (Bornioli et al., 2021; Murray et al., 2016; Sharpe et al., 2018). Evidence suggests that adolescent girls typically report higher levels of body dissatisfaction than boys (Holsen et al., 2012; Kantanista et al., 2015), which has led to the development of targeted prevention and early intervention programs for this group. However, more recently, approximately 50–69% of boys have also been found to experience pressures to achieve a lean and “healthy” appearance (Dove, 2024). Despite this, limited research has focused on developing body image interventions specifically for boys. While previous reviews have examined the effectiveness of body image interventions among mixed-gender adolescents (Yager et al., 2013), women (Lewis-Smith et al., 2016), and men (Hendricks et al., 2023), as well as the potential of positive body image interventions (Guest et al., 2022), no systematic review has comprehensively synthesized all existing body image interventions (targeting both positive and negative body image) specifically for boys. Given the recent shift in body image literature to include boys and men, an up-to-date and critical synthesis of the existing evidence is necessary. Therefore, this systematic review aims to synthesize and critically evaluate the effectiveness of body image interventions among boys.

Literature on Body Image Concerns Among Boys

Historically, body image concerns among boys have received less attention in research and policy compared to girls, partly due to a limited understanding of how body dissatisfaction presents in this demographic (Health & Social Care Committee, 2022). Recent evidence, however, reveals significant body dissatisfaction among boys. About 68% of boys are unhappy with their height, 74% of boys feel insufficiently muscular, and 59% of boys experience pressures to conform to attractive standards (Dove, 2024), such as looking masculine and aligning with mesomorphic appearance ideals (Sicilia et al., 2023). These appearance ideals differ from the body ideals that girls and women commonly feel pressured to pursue (i.e., maintaining a slim, slender, and fair body, with a small waist and minimal body fat; Mingoia et al., 2017). Notably, the significant biological and psychological changes experienced during adolescence, which relate to changes in physical appearance, sense of identity, and ability to form intimate relationships, increase the risk of negative body image at this developmental stage among both boys and girls (Blum et al., 2021; Krasniqi & Cakirpaloglu, 2020; Sicilia et al., 2023).

Regardless of whether boys desire to be thinner or more muscular (Calzo et al., 2015; Dakanalis et al., 2015), appearance-related concerns lead to high levels of distress and psychological issues, such as low self-esteem, depression, anxiety, suicidal thoughts, and an increased risk of eating disorders (Brausch & Muehlenkamp, 2007; Voelker et al., 2015; Walker et al., 2018). Alarmingly, to alter their appearance in pursuit of an “ideal” physique, 58% of boys engage in risky behaviors such as excessive exercise (27%) and unhealthy eating habits (31%), that negatively impact their quality of life (Dove, 2024; Gouveia et al., 2014; Yager & O’Dea, 2014). This underlines the need to address the unique appearance-related challenges boys face. However, it is important to note that much of the understanding around the nature and scale of body image concerns among this demographic is derived from studies that have been conducted among cisgender boys (Sicilia et al., 2023). Further, while some studies have demonstrated how the intersection of gender and body size influences body dissatisfaction, these studies were limited to adult men (Brewer et al., 2022; Strübel et al., 2020). Nonetheless, based on the findings of prior research, it is encouraging that negative body image is a modifiable risk factor, and early intervention can help prevent mental health issues among boys, including eating disorders, engagement in risky health behaviors, and depression, all of which are associated with body dissatisfaction (Bornioli et al., 2019).

Among the multitude of risk factors that lead to body image concerns (De Jesus et al., 2015; Holland & Tiggemann, 2016), the rising incidence of body dissatisfaction among boys has been partially attributed to heightened exposure to media depictions objectifying men and portraying them as lean and muscular (Chia & Wen, 2010). This media content fosters unattainable standards and emphasizes a gap between these ideals and one’s physique (Lorenzen et al., 2004) and pressures boys to pursue more muscular and leaner mesomorphic physiques (Murray et al., 2016; Neumark-Sztainer & Eisenberg, 2014). Further, boys may also confront appearance pressures from family and friends, with those who internalize these pressures experiencing higher body dissatisfaction (Tylka, 2021). The role of these risk factors has been outlined across several studies that empirically show how boys’ body dissatisfaction is caused by perceived pressures to adhere to a socially accepted appearance ideal from external social influences, predominantly parents, peers, and the media (Frederick et al., 2022; Papp et al., 2013). Body dissatisfaction becomes further normalized in environments like sports teams and gyms, where boys interact and face intensified pressure to conform to male appearance ideals (Perelman et al., 2018; Stapleton et al., 2016). For instance, gym-goers often share their progress and routines to inspire others, fostering comparisons and competitiveness. These combined pressures expose approximately 67% of boys, especially those with larger bodies, to vulnerability as they strive for physical attractiveness (Dove, 2024). Given these findings, there is an urgent need to develop new evidence-based interventions or tailor existing ones that alleviate body dissatisfaction and promote body confidence among boys (Matsumoto & Rodgers, 2020).

Evidence suggests that these risk factors propagate negative body image among boys across several high-, middle-, and low-income countries, such as Australia, Europe, North America, Indonesia, India, and Mexico (Rodgers et al., 2023), which makes them universal and potential factors to target through body image interventions. However, it is important to note that depending on the cultural context, these risk factors may impact body dissatisfaction variably. For instance, in Western individualistic contexts, social media and peer influences have been found to significantly affect adolescents’ negative body image (Frederick et al., 2022; Klimek et al., 2018). Conversely, in non-Western contexts, gender stereotypes may have a more profound impact on body dissatisfaction (De Jesus et al., 2015; Gattario et al., 2015). It is therefore important to synthesize evidence from body image interventions globally, to delineate their effectiveness across various countries and cultural contexts.

Body Image Interventions Among Boys

A diverse range of interventions, targeting the psychosocial risk factors discussed above, are currently being employed to alleviate body image concerns among adolescents. Notably, most of these interventions have been tested for their effectiveness in real-world conditions, rather than for their efficacy, which is tested under ideal and controlled settings, demonstrating the robustness of intervention effects in preventing body dissatisfaction (Singal et al., 2014). These interventions are often delivered in group settings (e.g., classroom-based settings) by varied trained individuals (e.g., teachers, psychology students, researchers, clinicians; Gordon et al., 2021; Halliwell et al., 2016; Lee et al., 2018; Saucedo-Molina et al., 2018; Stewart et al., 2022).

These interventions use varied approaches, including practical skill-building strategies focused on media literacy that equips individuals with skills that can allow them to become critical consumers of media, behavioral modification that facilitates modification of dysfunctional behaviors related to body dissatisfaction through techniques such as self-monitoring, and social learning that encourages learning from one’s own and others’ behaviors (Mora et al., 2015; Yager & O’Dea, 2010). Some interventions use mindfulness-based and self-compassion approaches focusing on psychological flexibility, alignment with personal values and bodily experiences, and self-compassion to promote body confidence (Albertson et al., 2014; Fogelkvist et al., 2020). Similarly, some interventions utilize a positive body image approach, encouraging individuals to appreciate their bodies and their functional abilities. This approach promotes awareness of the body’s needs and the ability to protect oneself against harmful appearance-related cultural messages, thereby fostering high body esteem and confidence (Matheson et al., 2020; Regehr et al., 2020). Cognitive dissonance-based interventions have shown promise in challenging appearance ideals by utilizing counter-attitudinal exercises to diminish the pursuit of unrealistic appearance standards (Diedrichs et al., 2021; Lewis-Smith et al., 2023). Further, dissonance-based interventions allow participants to recognize relationships between their thoughts, beliefs, and behaviors, which prompt them to break that cycle (Alleva et al., 2015). However, most of these interventions have been evaluated among mixed-gender adolescents, girls, or women, highlighting a gap in understanding their effectiveness specifically for boys (Bell et al., 2022; Pearson et al., 2012). Recent studies exploring dissonance-based interventions among men have also shown promising outcomes, yet their effectiveness in the real-world context among boys remains uncertain (Hendricks et al., 2023; Jankowski et al., 2017). The understanding of the extent to which existing body image interventions are effective among boys is therefore limited, which underlines a significant research gap that needs to be addressed.

Over the past decade, numerous systematic reviews have synthesized evidence on the effectiveness of body image interventions among adolescents. Some reviews have focused on the effectiveness of specific therapeutic approaches to mitigate body dissatisfaction, such as media literacy and physical activity interventions (Andermo et al., 2020; Kurz et al., 2022). Others have broadly investigated the effectiveness of school-based body image interventions for adolescents (Kusina & Exline, 2019; Yager et al., 2013). Conversely, a limited number of reviews have highlighted the effectiveness of standalone interventions aimed at promoting positive body image or identifying specific techniques that improve body image (Alleva et al., 2015; Guest et al., 2022). Although these reviews have enhanced the understanding of the effectiveness of current body image interventions and the characteristics that lead to improvements in body image outcomes, a common limitation is their focus on mixed-gender studies, often with a narrative primarily centered on girls. Notably, systematic reviews that have specifically addressed interventions for boys have mainly synthesized body image intervention literature within the context of physical activity or education (Bassett-Gunter et al., 2017; Kerner et al., 2022) or narrowed the review focus only to interventions focused on promoting positive body image (Guest et al., 2022). This underscores a significant research gap and the need to synthesize evidence regarding the effectiveness of a wide range of psychosocial interventions targeting body image among boys. This need is particularly critical given that many body image interventions, though effective for girls, have not significantly alleviated body dissatisfaction or promoted body confidence among boys (Bell et al., 2021; Halliwell et al., 2016).

Current Study

Despite numerous systematic reviews assessing body image interventions among adolescents, a comprehensive narrative discussion about the effectiveness of psychosocial body image interventions specifically for boys is notably absent. This review aims to fill this critical research gap and provide actionable recommendations for future body image intervention development tailored to boys. The primary aim of this review is to systematically synthesize and critically evaluate evidence on the effectiveness of body image interventions for boys. Second, it seeks to identify the therapeutic approaches currently used to improve body image among boys. This focus differentiates the current review from existing reviews that synthesize evidence on body image interventions among adolescents (Yager et al., 2013), women (Lewis-Smith et al., 2016), and men (Hendricks et al., 2023). By specifically analyzing body image intervention literature targeting boys, this review will offer crucial insights into intervention effectiveness for this demographic. This information is vital for future research aimed at adapting or developing interventions specifically designed to address negative body image and promote positive body image among boys. Enhancing the effectiveness of these interventions will not only alleviate body image concerns in this demographic but also reduce the risk of associated mental health conditions, such as eating disorders and depression (Bornioli et al., 2019).

Methods

This systematic review adhered to guidelines set out in the Cochrane Handbook for Systematic Reviews (Higgins et al., 2023) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement (Page et al., 2021), and followed a pre-registered review protocol (PROSPERO, ref no. CRD42023471009; can be accessed here).

Data Sources and Search Strategy

Database searches were conducted for universal intervention studies published from inception until 26 February 2024 using the following bibliographic databases: CINAHL, PsycINFO, PsycARTICLES, ERIC, MEDLINE (accessed via EBSCO), EMBASE (accessed via SCOPUS), and ProQuest (dissertations and theses). The bibliographic database search strategy was developed using MEDLINE (via EBSCO), and the design of the search strategy was informed by controlled headings (e.g., MeSH in MEDLINE). To counter publication bias and identify additional studies that may meet the inclusion criteria, a search of grey literature on Google Scholar was conducted. Additionally, a call requesting published and unpublished research was also posted via Emeritus Professor Levine’s e-newsletter (1105 body image and eating disorder researchers across 48 countries, as of 11 March 2024) and a backward citation search was carried out using the reference lists of the included studies and previous reviews. Boolean combinations, alternative spellings, and abbreviations of the following search terms were used, related to: (a) interventions (e.g., intervention, randomized controlled trial, experimental, cognitive dissonance, media literacy); (b) target outcomes (e.g., body satisfaction, body appreciation, appearance ideals, weight concern); and (c) target population (e.g., man, boys, male). The full search strategy, based on the current literature on this topic, can be found in Table S1 (Online Resource).

Study Eligibility Criteria

For this review, established definitions of the key constructs were followed. Specifically, body image is defined as a multifaceted construct referring to an individual’s perceptions, attitudes, and experiences toward their body (Cash, 2002). Positive body image is defined as an appreciation for the body, which encompasses acceptance, appreciation of its uniqueness, and a focus on its assets over its imperfections (Tylka & Wood-Barcalow, 2015). On the other hand, negative body image (also known as body dissatisfaction) refers to negative evaluations of, or attitudes toward, the body (Cash, 2002). The constructs of positive and negative body image are considered related but conceptually distinct; as such, an individual can experience both positive and negative body image simultaneously.

Studies were eligible for inclusion if they were: (a) published in English; (b) reported on the efficacy or effectiveness of a universal/preventative psychosocial body image intervention; and (c) were conducted among children and/or adolescents (generally defined as individuals under 18 years of age; however, studies were not excluded if a small subset of participants were just over 18). Interventions were categorized under intervention type based on descriptions provided by the authors in the published studies (e.g., media literacy, cognitive dissonance, positive body image, or combinations of the same). Further, eligible studies had to: (d) report changes from pre- to post-intervention in at least one body image outcome (e.g., body functionality, body esteem, body surveillance, body checking, internalization of appearance ideals, body (dis)satisfaction) and (e) report or provide (on request) sufficient data related to intervention effectiveness among boys specifically. In terms of study design, (f) all pre- to post-intervention evaluations were included irrespective of control groups and follow-up periods if they fulfilled the remaining criteria. No limits were placed on the date of publication, the country where the studies were conducted, the type of body image outcome, or the type of control group employed, to ensure a comprehensive selection of body image interventions that have been evaluated among boys was captured. Additionally, there were no exclusions based on sex assigned at birth; as such, all studies that reported on transgender or cisgender boys were eligible for inclusion. Finally, no exclusions were made based on whether the intervention targeted positive or negative body image.

Studies were excluded if participants were girls and/or women or adults above the age of 18 years. Mixed-gender studies were excluded if they did not provide intervention effects for boys separately or include gender as a covariate in their analyses. Studies assessing mixed-age samples were excluded as interventions for younger audiences need to be developmentally appropriate and adult concerns may vary considerably from children and adolescents (Tiggemann, 2004); exceptions were made if a small subset of participants were just over 18 and the mean age was below 18. Because this review aimed to understand the impact of psychosocial interventions on body image, interventions that solely focused on physical activity, nutrition, or other lifestyle behaviors without a body image component or were conducted among clinical populations were excluded, given the range of extraneous biopsychosocial factors that may be at play. Further, studies were also excluded if the intervention focused on eating disorders, rather than body image. This is because the current review focused on body image concerns, which, although related to eating pathology, stand as an independent public health concern. Finally, regarding study design, studies were excluded if they were reviews, meta-analyses, qualitative studies, cross-sectional studies, case series studies, or descriptive studies.

Study Selection

After piloting the title and abstract screening protocol to establish consistency, all extracted records were screened against the eligibility criteria by the first three authors (LA, JS, MB) using EndNote bibliographic manager (v. 20). A similar format was followed for the full-text screening of 186 studies. Inter-rater reliability for the full-text screening of records was assessed using Cohen’s kappa (Cohen, 1973), showing moderate agreement between scores (87.1%; κ = 0.690, p < 0.001). Regular meetings were held between the authors at both stages to discuss the inclusion of studies that authors were uncertain about. During these discussions, the eligibility criteria were consistently reviewed to justify the inclusion or exclusion of the studies, ensuring that all included studies met the eligibility criteria. No changes to the inclusion criteria were made at any stage.

Data Extraction

Two standardized data extraction forms were used to extract data from all eligible studies about the characteristics of the employed interventions (Table 1) and the findings of the studies (Table 2). For Table 1, the following data were extracted: (a) author(s) (year) and country of publication; (b) intervention name; (c) intervention duration (days or weeks, number and length of sessions); (d) who delivered the intervention; and (e) a brief description of the intervention. For Table 2, the following data were extracted: (a) author(s) (year); (b) sample characteristics (sample size, participants’ age); (c) study characteristics (study design, follow-up period, comparison group, body image measures); (d) findings related to body image outcomes among boys; and (e) quality assessment. The data extraction process was conducted independently by the first three authors (LA, JS, MB), following which a second reviewer checked the extraction to ensure eligibility, completeness, and accuracy. Authors were contacted to provide any missing data (e.g., separate results for boys). However, if the authors were unapproachable or were unable to provide the requested information within the timeframe of the review, the studies under question were excluded.

Table 1 Description of evaluated interventions
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Table 2 Characteristics of the included studies and results related to boys’ body image
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Data Synthesis

Included studies were examined for methodological heterogeneity, revealing notable differences (e.g., participant characteristics, research design, outcome measurement techniques). The interventions further exhibited significant variations in approach, content, delivery methods, and duration. Consequently, conducting a narrative synthesis approach was deemed more appropriate than a meta-analysis (Mays et al., 2005). This decision was undertaken for two reasons. First, in conducting a meta-analysis, different body image constructs would need to be collapsed into one outcome, such that change in the pooled construct can be determined as a result of the interventions (Ahn & Kang, 2018). This would require the grouping of different variables, which may assess slightly different constructs (e.g., muscular ideal internalization and pressure to be muscular), or the exclusion of certain outcomes that are only assessed in a handful of studies (e.g., attitudes towards anabolic androgenic steroid use). Second, as the overarching objective of the current review was to inform future intervention development, a narrative synthesis was deemed more informative and useful in enabling a comprehensive and nuanced exploration of the different approaches currently used, as well as their effectiveness (Mays et al., 2005). The chosen approach therefore aligns with prior research suggesting the preference for systematic reviews over quantitative syntheses when significant heterogeneity is present across the included studies (Charrois, 2015; Impellizzeri & Bizzini, 2012).

Data were organized by grouping studies based on their intervention approach (as defined by the authors in the published studies), including media literacy, socio-cognitive approaches, combined media literacy and cognitive dissonance, positive body image and embodiment, compassion and mindfulness, and other or unspecified approaches. The findings are also presented in relation to intervention effectiveness and methodological quality (see Tables 1, 2).

Quality Assessment

Given the varied study designs included in this review, the quality of the included studies was assessed using the Effective Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies (EPHPP; Thomas et al., 2004), selected for its ability to assess a wide range of studies, including non-randomized trials and mixed-methods studies. The EPHPP evaluates quality across six domains: (a) selection bias; (b) study design; (c) confounders; (d) blinding; (e) data collection methods; and (f) withdrawals and dropouts. Each domain is rated as “strong”, “moderate”, or “weak” based on its design and reporting practices. A cumulative final score of overall strength is then assigned based on these ratings, such that no weak ratings = “strong”, one weak rating = “moderate”, and two or more weak ratings = “weak” (Thomas et al., 2004). To ensure consistency, the first three authors (LA, JS, MB) independently scored each study, with each study being evaluated twice. The authors then compared their assessments to achieve consensus. Inter-rater reliability was assessed using Cohen’s kappa (Cohen, 1973), showing moderate agreement between scores (78.0%; κ = 0.624, p < 0.001). Any discrepancies in ratings were resolved through extensive discussion within the reviewing team before a final decision about the quality of each study was made.

Results

Study Selection

The initial searches identified a total of 24,544 studies. After removing duplicates (n = 1,417), three authors screened the titles and abstracts of 23,127 studies for relevance, and 22,941 records were excluded based on this screening. Following this, 186 studies were selected for full-text review and 145 were excluded when assessed against the eligibility criteria. This led to the identification and inclusion of 41 studies (see Fig. 1).

Fig. 1
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PRISMA flowchart of study selection

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Study Characteristics

Most of the included studies were conducted in Australia (k = 13), followed by the United Kingdom (k = 9) and the United States (k = 5); two studies each were conducted in Canada, Germany, Mexico, and South Korea; and one study each was conducted in Brazil, India, Indonesia, Ireland, Israel, Norway, and Spain. The total number of participants across all studies was 21,707 (approximately 50% boys), with sample sizes ranging from 77 to 2446 participants per study. All included interventions were evaluated for effectiveness and the majority were evaluated in a school setting, except for three studies that employed in-person (k = 2; Matheson et al., 2020; Swami et al., 2022) or online community settings (k = 1; Matheson et al., 2023). Almost all studies were conducted in mixed-gender groups (k = 38), with only three studies targeting boys exclusively. Boys-only interventions were based on socio-cognitive approaches (k = 1; 33.3%) and other or unspecified approaches (k = 2; 66.7%). Mixed-gender approaches included media literacy (k = 10; 24.4%), socio-cognitive approaches (k = 10; 24.4%), combined cognitive dissonance and media literacy-based approaches (k = 8; 19.5%), positive body image and embodiment (k = 6; 14.6%), compassion and mindfulness (k = 4; 9.8%), and other or unspecified approaches (k = 3; 7.3%). Note that three studies compared multiple approaches. Interventions ranged from single-session approaches to three-month interventions, and the duration of the follow-up assessment period ranged from no follow-up to 36 months. The number of sessions ranged from 1 to 11 sessions (M = 5.32 sessions, SD = 2.95), with each session lasting up to 90 min (M = 52.42 min, SD = 19.32). A wide range of body image measures were included (see Table 2), with most studies assessing body (dis)satisfaction as the primary outcome.

Study Quality

Most studies were rated as methodologically “weak” (k = 20; 48.8%) or “moderate” (k = 13; 31.7%), with only eight studies (19.5%) rated as “strong”. Weak component ratings were predominantly seen for confounders (i.e., many studies did not control for relevant confounders such as baseline body image scores, found differences in baseline body image scores between the intervention and control groups, and/or did not explicitly discuss how they controlled for confounders in their analyses) and withdrawals and dropouts (i.e., participant numbers dropped significantly from pre- to post-intervention and follow-up).

Effectiveness of Boys-Only Interventions

Only three studies (evaluating three interventions) included boys-only samples and assessed similar body image outcomes, including body (dis)satisfaction, thin and muscular ideal internalization (i.e., internalizing—or adopting as one’s own—the ideal of a body with low body fat and/or high muscularity), pressures to be thin or muscular, strategies to increase muscularity, negative body talk (i.e., negative comments about bodies or appearances during social conversations), attitudes towards anabolic androgenic steroid (AAS) use, intentions to use AAS, social norms for AAS, and AAS and supplement use (McCabe et al., 2010; Stanford & McCabe, 2005; Yager et al., 2023). The quality of these studies ranged from weak (k = 2) to moderate (k = 1). Interventions included Goodform, which was based on cognitive dissonance, social learning theory, and the social norms approach and drew from the Athletes Training and Learning to Avoid Steroids (ATLAS) program and The Body Project: More Than Muscles (Doley et al., 2020, 2021; Yager et al., 2023), and two bespoke interventions, which did not specify their theoretical underpinnings (McCabe et al., 2010; Stanford & McCabe, 2005). Only one study reported significant results, which found that boys’ satisfaction with their muscles improved from pre- to post-intervention, but this finding needs to be interpreted with caution due to the small sample size and low response rate (Stanford & McCabe, 2005). No other changes in body image or related outcomes were observed at post-intervention (McCabe et al., 2010; Stanford & McCabe, 2005; Yager et al., 2023) or follow-up (McCabe et al., 2010; Yager et al., 2023).

Effectiveness of Mixed-Gender Interventions

Media Literacy

Media literacy, examined by 10 studies (evaluating five interventions), was one of the two most adopted approaches for body image interventions in mixed-gender settings. Media literacy interventions seek to improve critical thinking by boosting understanding of the media, raising awareness of its influence, and enhancing one’s ability to evaluate how accurately the media portrays reality. This approach is intended to lessen the media’s impact on individuals’ beliefs, attitudes, norms, and behaviors (Jeong et al., 2012). Regarding study quality, only one study was found to be methodologically strong, and most studies were rated as moderate (k = 6), while the remaining studies were rated as methodologically weak (k = 3).

Evidence regarding the effectiveness of media literacy interventions was also mixed. In terms of body (dis)satisfaction, three studies showed no effects (Gordon et al., 2021; Wade et al., 2003; Warschburger & Zitzmann, 2018), while three studies found significant improvements at post-intervention (Richardson et al., 2009; Wilksch & Wade, 2009; Wilksch et al., 2015) and follow-up (Richardson et al., 2009), with effects retained at six months in one study (Wilksch & Wade, 2009), but not another (Wilksch et al., 2015). Wilksch and Wade’s (2009) positive impact on body (dis)satisfaction was not retained at 30 months. The interventions showing evidence of effectiveness on boys’ body (dis)satisfaction were driven by weak and moderate quality studies, while the study rated as strong showed no effects (Gordon et al., 2021). No change was observed in body esteem (i.e., the attitudes, evaluations, and feelings an individual holds about their own body) at post-intervention (Halliwell et al., 2016; Lee et al., 2018) or follow-up (Kwag et al., 2021; Lee et al., 2018).

Findings were also mixed regarding other body image-related outcomes. Two studies rated as weak showed improvements in shape and weight concerns at post-intervention (Wade et al., 2003) and follow-up (Wade et al., 2003; Wilksch & Wade, 2009), while two studies showed no change (Gordon et al., 2021; Wilksch et al., 2015). Similarly, two moderate studies showed reduced internalization of media or appearance ideals at post-intervention (Wilksch et al., 2006, 2015) and at six and twelve months (Wilksch et al., 2015); however, five studies provided contradictory evidence (Gordon et al., 2021; Halliwell et al., 2016; Richardson et al., 2009; Warschburger & Zitzmann, 2018; Wilksch & Wade, 2009). Reduction in appearance- and weight-related teasing at post-intervention was found in one study (Wilksch et al., 2015). However, this effect was not maintained at follow-up (Wilksch et al., 2015), and one study showed no change in this outcome (Richardson et al., 2009). No improvements were observed in perceived media pressure (Halliwell et al., 2016; Wilksch & Wade, 2009), awareness of media ideals (Halliwell et al., 2016), or body and appearance comparisons (Gordon et al., 2021; Richardson et al., 2009). Furthermore, one study showed worse outcomes in the intervention condition, as boys reported increased drive for muscularity (i.e., desire to be highly muscular) following the intervention, compared to the control group (Gordon et al., 2021).

Socio-Cognitive Approaches

Ten studies (evaluating eight interventions) assessed body image interventions based on socio-cognitive approaches (including cognitive dissonance and social learning theory). Sociocognitive interventions for body image focus on improving an individual’s perception and attitudes towards their body through a combination of cognitive, behavioral, and social strategies (Hamamoto et al., 2024). The evidence regarding the effectiveness of interventions using such approaches was mixed. With regards to body (dis)satisfaction, three studies (all rated as moderate) showed improvements at post-intervention and follow-up (de León et al., 2008; Kristoffersen et al., 2022; Stewart et al., 2022), while five studies showed no effects (Atkinson et al., 2023; Bird et al., 2013; Jordana Ovejero et al., 2020; Saucedo-Molina et al., 2018; Wilksch et al., 2015). Similarly, body esteem improved at post-intervention and follow-up in one study, which was rated as methodologically strong (Atkinson et al., 2023) but remained unchanged in two studies (Miyairi et al., 2015; Smolak et al., 1998).

Findings were also mixed for appearance ideal internalization (Atkinson et al., 2023; Bird et al., 2013; Jordana Ovejero et al., 2020; Kristoffersen et al., 2022; Miyairi et al., 2015; Stewart et al., 2022; Wilksch et al., 2015) and appearance comparisons (Bird et al., 2013; Stewart et al., 2022). No change was observed in appearance teasing (Bird et al., 2013; Miyairi et al., 2015; Smolak et al., 1998), shape and weight concerns (Atkinson et al., 2023; Wilksch et al., 2015), drive for muscularity (Saucedo-Molina et al., 2018), or appearance conversations (i.e., conversations about topics related to the body and/or appearance) (Stewart et al., 2022). One study found worsened outcomes at post-intervention, specifically related to boys’ weight and shape concerns, trait media pressure, and body appreciation (Kristoffersen et al., 2022). Overall, the evidence for using socio-cognitive approaches to target body image concerns among boys was limited. This was further compounded by the methodological quality of the included studies, with most being rated as weak (k = 5), four rated as moderate, and only one study rated as strong.

Cognitive Dissonance and Media Literacy-Based Approaches

Eight studies (evaluating five interventions) employed interventions based on a combination of cognitive dissonance and media literacy. Cognitive dissonance interventions for body image are psychological strategies designed to reduce the conflict between an individual’s self-perception and societal or internalized standards of beauty. These interventions aim to challenge and change harmful beliefs and behaviors related to body image (Halliwell & Diedrichs, 2014). With regards to body (dis)satisfaction, only one study that was rated as methodologically strong showed improvements in this variable at post-intervention and follow-up (Bell et al., 2022), while three studies of varying quality showed no effects (Bell et al., 2021; Diedrichs et al., 2015; Golan et al., 2014). Similarly, with regards to body esteem, one weak and one strong study showed beneficial effects at post-intervention (Lewis-Smith et al., 2023) and follow-up (Lewis-Smith et al., 2023; McCabe et al., 2017), while two strong studies showed no effects (Craddock et al., 2024; Diedrichs et al., 2015), and one study showed that although body esteem improved at post-intervention and at two and three months, effects were not sustained at 12, 24, or 36 months (Diedrichs et al., 2021). Relatedly, one study found an improvement in boys’ muscle esteem at post-intervention and follow-up (McCabe et al., 2017).

Findings were also mixed regarding other outcomes related to body image. One study found a reduction in boys’ drive for thinness at post-intervention and follow-up (Golan et al., 2014). One study also found an increase in awareness of sociocultural pressures at post-intervention (Diedrichs et al., 2015); however, this increase was not sustained at follow-up (Diedrichs et al., 2015), and one study found no change on this outcome (Diedrichs et al., 2021). Similarly, one study found improvements in boys’ appearance ideal internalization at follow-up only (Lewis-Smith et al., 2023), while five studies found no effects on this outcome (Bell et al., 2021, 2022; Craddock et al., 2024; Diedrichs et al., 2015, 2021). Further, no changes were observed in boys’ body change strategies (i.e., strategies and behaviors employed to attempt to change one’s body shape or size, including through food and exercise) (McCabe et al., 2017), appearance conversations (Bell et al., 2021; Diedrichs et al., 2015, 2021), appearance comparisons (Craddock et al., 2024; Diedrichs et al., 2015, 2021), appearance teasing (Diedrichs et al., 2015, 2021), self-objectification (Bell et al., 2021, 2022), perceived pressure (McCabe et al., 2017), or skin shade satisfaction (Craddock et al., 2024).

Overall, the evidence for using a combined approach of media literacy and cognitive dissonance among boys was limited, despite most studies being rated as methodologically strong (k = 5), with only one study rated as moderate and two studies rated as weak. Despite the methodological rigor observed in studies employing this theoretical approach, the mixed findings make it difficult to draw sound conclusions about the interventions’ effectiveness.

Positive Body Image and Embodiment

Six studies (evaluating six interventions) examined body image interventions that used positive body image approaches. Positive body image interventions are strategies and activities designed to enhance an individual’s appreciation and acceptance of their body. These interventions aim to foster a positive and healthy relationship with one’s body, focusing on body functionality, self-compassion, and resilience against societal pressures (Tylka & Wood-Barcalow, 2015). Relatedly, embodiment refers to a way of engaging with the body that fosters a deep, connected, and intimate relationship, allowing one to effectively understand, respect, and express bodily experiences and needs. Embodiment is considered a protective factor for positive body image (Piran, 2015). Notably, most of these intervention approaches were used in combination with others, including media literacy and cognitive dissonance.

Although two studies (one of moderate and of one strong quality) found improvements in body (dis)satisfaction at post-intervention (Matheson et al., 2020, 2023), one study rated as weak showed no effect (Norwood et al., 2011), and two studies showed that a positive body image intervention was not more effective than a control condition at improving body (dis)satisfaction among boys (Matheson et al., 2020; Regehr et al., 2020). Results were also mixed regarding positive body image outcomes, specifically body appreciation, with one study showing that the intervention was effective at improving body appreciation (Swami et al., 2022) and one study showing no significant effects at post-intervention (Regehr et al., 2020). Relatedly, although Sundgot-Borgen et al. (2019) found improvements in positive body embodiment at post-intervention, this effect was not sustained at follow-up. However, significant effects were observed for body and appearance esteem (Matheson et al., 2023; Norwood et al., 2011), body image coping strategies (i.e., techniques and methods individuals use to manage and mitigate negative thoughts and feelings about their bodies) (Regehr et al., 2020), and internalization of appearance ideals (Norwood et al., 2011) at post-intervention. No changes were observed in body image self-efficacy (Matheson et al., 2023).

Overall, these findings show potential promise of positive body image and embodiment approaches at targeting body image concerns among boys, particularly with regards to positive body image outcomes. However, conclusive claims cannot be drawn from these studies as half were found to be methodologically weak (k = 3), two studies were rated as moderate, and only one study was rated as methodologically strong.

Compassion and Mindfulness

Four studies (evaluating four interventions) utilized compassion- or mindfulness-based approaches. Mindfulness-based interventions are therapeutic approaches that incorporate mindfulness practices to promote mental and physical well-being. These interventions focus on cultivating awareness and acceptance of the present moment, helping individuals to manage stress, improve emotional regulation, and enhance overall quality of life (Shapero et al., 2018). On the other hand, compassion-based interventions are approaches designed to foster compassion towards oneself and others, promoting emotional healing, resilience, and well-being. These interventions focus on developing skills of empathy, kindness, and understanding, and are often used to address issues such as self-criticism, shame, and trauma (Kirby, 2017).

No changes in boys’ body esteem (Atkinson et al., 2023), body (dis)satisfaction (Atkinson et al., 2023; Kristoffersen et al., 2022), self-concept (Portele & Jansen, 2023), body appreciation (Kristoffersen et al., 2022; Mahon & Hevey, 2023), internalization of appearance ideals (Atkinson et al., 2023; Kristoffersen et al., 2022; Mahon & Hevey, 2023), weight and shape concerns (Atkinson et al., 2023; Kristoffersen et al., 2022), appearance evaluation (i.e., positive and negative appraisals of, and beliefs about, one’s appearance) (Mahon & Hevey, 2023), appearance comparisons (Mahon & Hevey, 2023), or self-criticism (Mahon & Hevey, 2023) were found following the interventions. Although Mahon and Hevey (2023) found that boys’ body satisfaction increased from post-intervention to three-month follow-up, this study was of weak methodological quality. Overall, compassion- and mindfulness-based approaches were identified as less effective based on the studies included in this review. As with other approaches, these findings need to be taken with caution, given that only one study was rated as strong, one was rated as moderate, and half were rated as weak (k = 2).

Other Approaches

Three studies (evaluating three interventions), all rated as weak on methodological quality, utilized other intervention approaches that showed limited effectiveness for boys’ body image outcomes. McCabe et al.’s (2006) Active Children and Esteem Study was designed to improve body satisfaction, lower negative affect, and improve positive affect among boys and girls. Although boys in the intervention group showed reduced levels of negative affect over time, no significant change was observed in body dissatisfaction (McCabe et al., 2006). Similarly, a study by Kintner (2020) employing an intervention based on relational-cultural theory, resiliency practices, and motivational interviewing techniques (Girls Circle/The Council) found no change in boys’ body image following the intervention. Finally, Kater et al.’s (2002) study explored the effectiveness of the Healthy Body Image: Teaching Kids to Eat and Love Their Bodies Too! intervention, which aimed to educate children about body size, shape, and composition, covering topics such as changes during puberty, genetic diversity, internal weight regulation, and the dangers of dieting. Although the intervention reduced boys’ prejudicial attitudes about body size and improved knowledge and media awareness, self-image scores dropped at post-intervention and no change was observed in boys’ body image scores.

Overall, these findings highlight the inconclusive effectiveness of existing body image interventions among boys, regardless of whether the interventions use standalone or mixed therapeutic approaches.

Discussion

Despite increasing body image concerns among boys, which can lead to negative physical and mental health outcomes, no systematic review has specifically synthesized and critically evaluated the effectiveness of body image interventions for this demographic. Instead, several reviews have focused on reporting the effectiveness of body image interventions among mixed-gender adolescents (Yager et al., 2013), women (Lewis-Smith et al., 2016), and men (Hendricks et al., 2023). Further, it remains unclear which therapeutic approaches underpin the effective and ineffective body image interventions among boys. Recognizing this research gap, this systematic review comprehensively evaluated the effectiveness of body image interventions for boys and identified the therapeutic approaches used to enhance their body image. By analyzing the key characteristics of both effective and ineffective interventions, this review offers crucial insights to improve future research and develop accessible and effective interventions that specifically target boys’ body image concerns.

Given the limited focus on interventions targeted towards boys specifically, mixed-sample studies that provided effectiveness data for boys were included. Among the 41 studies reviewed, only three studies (evaluating three interventions) exclusively targeted boys, while 38 studies (evaluating 31 interventions) involved mixed-gender groups. These interventions employed diverse therapeutic approaches, including media literacy, socio-cognitive approaches, combined cognitive dissonance and media literacy, positive body image and embodiment techniques, compassion and mindfulness practices, and other or unspecified approaches. While the extensive use of varied therapeutic approaches was noted, no single approach was found to be universally effective among boys (Bell et al., 2021; Jordana Ovejero et al., 2020; Lee et al., 2018), although some effectiveness was evidenced for approaches employing positive body image and embodiment techniques. However, these findings need to be interpreted in light of the relatively low number of studies adopting this approach (k = 6) and the poor quality of the included studies. Further, while some interventions showed overall effectiveness on boys’ body image outcomes, the majority benefitted girls more than boys (e.g., Atkinson et al., 2023; Gordon et al., 2021; Wilksch et al., 2015), and evidence of intervention effectiveness was often driven by studies of lower quality. These findings illustrate that evidence regarding the effectiveness of current body image interventions for boys is inconclusive, and emphasize the need to improve existing interventions or develop new ones tailored to addressing escalating body image concerns among this population (Hendricks et al., 2023).

Out of the 41 studies reviewed, most studies were deemed of low quality, followed by medium quality, with only eight demonstrating strong methodological rigor. Within these high-quality studies, two assessed media literacy and cognitive dissonance as separate approaches (Atkinson et al., 2023; Gordon et al., 2021), five explored combined media literacy and dissonance strategies (Bell et al., 2021; Craddock et al., 2024; Diedrichs et al., 2015, 2021; Lewis-Smith et al., 2023), and two focused on mindfulness (Atkinson et al., 2023) and positive body image and embodiment techniques (Matheson et al., 2020). Although the intervention utilizing a positive body image approach achieved immediate improvements in boys’ body satisfaction, these effects were not sustained at follow-up (Matheson et al., 2020) and the remaining interventions failed to alleviate body image concerns in boys (Bell et al., 2021; Craddock et al., 2024; Stewart et al., 2022) or were more effective for girls than boys (Atkinson et al., 2023; Diedrichs et al., 2015, 2021; Gordon et al., 2021). Seven of these strong studies were conducted in classroom settings with mixed samples, featuring multisession interventions spanning from one to five sessions. Each session lasted between 45 and 90 min and was facilitated by individuals with diverse backgrounds and expertise, including teachers, psychologists, researchers, and graduate students. These findings underscore critical considerations for future interventions targeting boys. Specifically, there is a need for tailored interventions distinct from those designed for girls and mixed-gender groups (Yager et al., 2013). Classroom-based interventions may not resonate effectively with boys, who often struggle to discuss body image issues openly, possibly due to feeling discomfort or vulnerability in the presence of girls (Paxton, 2002). Additionally, current interventions may be influenced by female-centric models and concerns (Kintner, 2020; Saucedo-Molina et al., 2018), potentially limiting their acceptability and effectiveness for boys. Shorter, interactive interventions using micro-intervention techniques, such as brief animations, may hold more promise for engaging and impacting boys effectively (Matheson et al., 2020). Additionally, considering the variation in research methods used across studies, further rigorous investigation of existing interventions using similar research designs, samples, and outcome measures is required, so that between-intervention effectiveness can be assessed.

Research indicates a growing prevalence of body image concerns among boys (Calzo et al., 2015; McCabe et al., 2010), but only three interventions specifically addressed this issue (McCabe et al., 2010; Stanford & McCabe, 2005; Yager et al., 2023). One intervention successfully improved muscularity satisfaction post-intervention (Stanford & McCabe, 2005), while two others showed no significant improvements in boys’ body image outcomes, possibly due to high baseline body satisfaction scores. It is plausible that the unsuccessful interventions inadequately addressed body image concerns (McCabe et al., 2010) or focused too narrowly on social norms and intentions related to steroid use (Yager et al., 2023), which may not apply to all boys (Goldman et al., 2019). Interventions focused on supplement use and muscularity may also be more effective for older at-risk boys but less relevant for younger boys (Calzo et al., 2015). Therefore, it could be inferred that interventions targeting multiple risk factors of body image concerns may be more promising and effective in addressing body dissatisfaction among universal samples of boys. This could also explain why several studies evaluating interventions heavily reliant on a dissonance-based approach, that targets the internalization of appearance ideals in countering body dissatisfaction, showed limited effectiveness in improving boys’ body image and related outcomes (Bell et al., 2021; Craddock et al., 2024; Stewart et al., 2022; Wilksch et al., 2015). Thus, future interventions for boys should consider age-appropriate content and comprehensive approaches targeting various body image risk factors that are embedded in theoretical underpinnings that are relevant to boys.

Studies also show wide-ranging benefits of fostering body confidence and positive body image (i.e., a distinct multidimensional construct that encompasses body appreciation, body acceptance, functional body satisfaction and orientation, and body image flexibility; Tylka & Wood-Barcalow, 2015) for overall physical and mental health, particularly in addressing body dissatisfaction (Guest et al., 2022). Considering this, six studies assessed interventions based on positive body image principles (Matheson et al., 2020, 2023; Norwood et al., 2011; Regehr et al., 2020; Sundgot-Borgen et al., 2019; Swami et al., 2022). All interventions demonstrated some improvements across different body image outcomes (e.g., body satisfaction, body esteem, embodiment, body appreciation), suggesting this therapeutic approach shows promise. Interestingly, one study found that the intervention was more effective for boys compared to girls (Regehr et al., 2020), aligning with evidence that strategies focusing on body appreciation, functionality, and resistance to media pressures can effectively enhance boys’ body confidence. However, none of these interventions measured changes in body functionality, which may be crucial for boys and men who often evaluate their bodies in terms of functionality, rather than appearance (Alleva & Tylka, 2021; Grogan & Richards, 2002). This highlights the challenge of drawing definitive conclusions without assessing changes in broader body image constructs that are targeted by the intervention. While two studies used the Body Appreciation Scale (Avalos et al., 2005) to assess body appreciation among boys, this scale may not fully capture the multifaceted nature of positive body image. Thus, to obtain conclusive findings about intervention effectiveness, it is essential to employ appropriate measures that holistically assess body image, including both positive and negative aspects of this construct, as well as facets related to both the appearance and functionality of the body (Gleeson & Frith, 2006).

This review identified some recurrent methodological trends across the included studies. Most studies used body (dis)satisfaction as a primary measure of effectiveness. However, research suggests that improvements in body satisfaction alone may not fully capture changes in the complex construct of body image, as described above (Andersen & Swami, 2021; Ginis et al., 2012). Furthermore, individuals who perceive that their bodies align with current appearance ideals may disproportionately influence these satisfaction measures (Kakar et al., 2023). Several studies used general body image measures that focus on body (dis)satisfaction and body esteem, overlooking specific concerns among boys like drive for muscularity (McCreary, 2007). Further, these outcome measures were originally designed for young women, and may therefore be less suitable for use among boys (Murray et al., 2016). To gain a more meaningful evaluation of interventions that are tailored to boys’ unique body image concerns, it would be important to measure changes in satisfaction with specific appearance features (e.g., skin color, hair), alongside other outcomes that may influence, and be influenced by, body (dis)satisfaction, including interpersonal relationships, life engagement, and resilience against external pressures (e.g., media). This holistic approach is essential, especially given the impact of social media on boys’ perceptions of themselves (Dove, 2024).

Moving forward, it is crucial for researchers to adopt more relevant outcome measures to accurately assess intervention effectiveness. Additionally, although an evaluation of intervention feasibility and acceptability was beyond the scope of the current review, several studies noted lower feasibility and acceptability of interventions among boys, compared to girls (e.g., Atkinson et al., 2023; Mahon & Hevey, 2023), underscoring the need for innovative intervention formats and safe environments for boys to openly discuss their body image concerns. This is critical for developing effective body image interventions that address boys’ unique needs.

Limitations

The current systematic review represents the first comprehensive synthesis of body image interventions specifically targeting boys. While this review followed a rigorous methodology to synthesize existing evidence, several limitations must be acknowledged. First, the heterogeneity among studies precluded a meta-analysis, limiting firm conclusions and specific recommendations, a common challenge in social science research (Jackson & Waters, 2005). Additionally, the diverse body image outcome measures used across studies hindered direct comparisons. This is a common limitation across different mental health topic areas and underlines the need to standardize the measurement process when effectiveness studies are conducted. Second, most included studies were conducted in high-income countries, questioning the generalizability to other populations and cultures, and were potentially affected by selection bias (Khazaal et al., 2014). Moreover, many interventions were culturally biased towards Western appearance ideals, neglecting the diverse influences boys encounter via social media. Evaluating interventions across cultures is thus recommended, with necessary adaptations. This, therefore, highlights an important future research avenue. Other included studies sampled low proportion of boys in mixed-gender studies, insufficiently reported gender-based analyses, and did not use active control groups (Alleva et al., 2015; Portnoy et al., 2008). These observations are key for future researchers to consider when conducting research in this area. Third, the review focused on English-language publications, potentially introducing publication bias despite efforts to diversify search strategies for comprehensive evidence collection. While this could have been prevented, language restrictions in systematic reviews are particularly frequent (Helbach et al., 2022; Pieper, 2021) and were unfortunately unavoidable given the lack of resources available to translate and extract data from non-English studies. Although prior research has found that excluding non-English publications may not substantially change systematic review findings (Nussbaumer-Streit et al., 2020), future researchers should attempt to explore non-English literature to gain a more comprehensive overview of the effectiveness of body image interventions among boys globally. Finally, efforts to obtain additional data were met with limited success, potentially impacting study inclusion.

Implications and Future Research

There is a notable scarcity of effective and specifically tailored body image interventions for boys, with existing interventions often proving inadequate and narrow in scope. While universal classroom-based interventions have demonstrated success in addressing body image concerns within mixed-gender groups, their effectiveness when applied solely to boys remains questionable. Future research should prioritize developing or adapting interventions explicitly designed to target boys’ unique body image concerns. However, before pursuing such initiatives, it is crucial to deepen the empirical understanding of the appearance-related issues boys face, including the sources of these pressures and the most effective intervention approaches. Engaging boys in the co-creation and development of interventions is essential to ensure their acceptability and effectiveness. These interventions must undergo acceptability testing to ensure the content is appropriate for boys before large-scale implementation.

Future interventions should also expand beyond conventional media influences to address broader cultural factors, such as the cosmetic, grooming, and pornography industries impacting boys’ body image perceptions (Maheux et al., 2021; Tylka, 2015), which is currently lacking in existing interventions for this demographic. Additionally, it is imperative to explore the influence of masculine norms on boys’ body image (Gattario et al., 2015) and challenge detrimental norms through targeted interventions. Future studies should use high-quality research designs (e.g., randomized controlled trials) with extended follow-up periods (e.g., ≥ one year) to minimize bias and provide definitive evidence of intervention effectiveness. Standardizing measures across studies will facilitate meaningful comparisons and enhance the overall understanding of intervention outcomes. Further investigation is also required to assess intervention effectiveness in high-risk populations such as athletes (Hogans & Seock, 2022), given the observed ceiling effects in the current studies. Based on the current body image literature, it is clear that studies have predominantly sampled cisgender boys, or have not provided sufficient information regarding participants’ gender identity. This limits understanding of how boys’ gender identity impacts their positive and negative body image. Thus, future research needs to address this research gap and account for this perspective when designing body image interventions for this group. Further, it is also important to consider that with constantly evolving appearance ideals, girls are pursuing leanness and muscularity more, while boys, on the other hand, are also pursuing thinness. This highlights the dimensional nature of body image concerns and questions the dichotomous approach that interventions take when targeting risk factors such as appearance ideals, internalization of these ideals, and media messaging to promote body confidence. Investing in rigorous studies exploring positive body image approaches is essential, drawing from evidence in men’s body image literature that suggests a greater appreciation for functional body aspects. Targeting the multifaceted nature of body image among boys holds promise for achieving comprehensive improvements in their body image outcomes.

Aside from the above adaptations to the content and delivery of existing interventions, as well as the methodology adopted in evaluation studies, several novel approaches may be useful to enhance body image among boys. First, given some promising evidence regarding the effectiveness of positive body image and embodiment techniques in this and other reviews (e.g., Guest et al., 2022), positive body image techniques can be combined with other approaches to target boys’ body image concerns more comprehensively. However, it should be noted that combining multiple approaches can increase intervention length and therefore participant and researcher burden, which could make the intervention less acceptable. Second, as described above, novel interventions are required that address contemporary influences on boys’ body image, such as those from the cosmetic, grooming, pornography, and fitness industries. This can be done by collaborating with industry partners that actively contribute to fostering young people’s well-being as a part of their social responsibility and have networks and resources to create social awareness and real-world impact. Third, and relatedly, future interventions should consider utilizing novel delivery methods and contemporary tools that may be more acceptable and effective among boys, such as micro-interventions on social media (Fardouly et al., 2023). Finally, recent research from the eating disorder (Isserlin et al., 2024; Rodgers et al., 2024) and mental health fields (Lippold et al., 2024) show promise of including parents to improve children’s outcomes. Fathers may be a particularly important influence for boys’ body image (Damiano et al., 2015; Tylka, 2021), but, at present, to the authors’ knowledge, no intervention has adopted dyadic approaches targeting boys and their fathers. As such, it is recommended that intervention developers account for contemporary considerations and influences in the development, delivery, and evaluation of body image interventions for boys.

Conclusion

Negative body image is a significant public health concern among adolescents and is associated with adverse physical and mental health outcomes, with recent studies indicating that boys are increasingly dissatisfied with their appearance. In response, body image experts have developed interventions to address body dissatisfaction among adolescents. However, the effectiveness of current interventions for boys remains inconclusive. Additionally, no systematic review has comprehensively assessed the effectiveness of body image interventions for boys, nor identified the therapeutic approaches underlying existing interventions, while evaluating the quality of the published evidence. Thus, this systematic review addressed this critical research gap by synthesizing evidence from 41 studies that evaluated the effectiveness of body image interventions among boys. While three studies exclusively targeted boys, most interventions were conducted in mixed-gender groups. Various approaches were employed, including media literacy, socio-cognitive strategies, combined cognitive dissonance and media literacy approaches, positive body image and embodiment techniques, compassion and mindfulness, and other or unspecified methods. Yet, outcomes and methodologies varied considerably. Interventions utilizing positive body image and embodiment techniques showed some promise in influencing boys’ body image outcomes. However, these results should be interpreted cautiously due to the limited number of interventions currently adopting this approach. Overall, findings suggest that the effectiveness of existing body image interventions for boys is inconclusive. This underscores the need for tailored interventions and replicating studies that evaluate interventions with limited positive effects, using consistent formats and measurement tools. Finally, high-quality studies and attention to implementation differences are essential to evaluate new stand-alone interventions that can alleviate body dissatisfaction and foster body confidence among boys. Overall, this systematic review discusses the effectiveness of existing body image interventions among boys and lays the foundation for future research.