The Psychological Impact of Societal Beauty Standards: A Systematic Review of Body Image Issues, Awareness Campaigns and the Role of Palliative Care in the Digital Era

Eligibility criteria

Peer-reviewed studies published between January 2004 and April 2024 were included. Adolescents and young adults (ages 10–30) were the primary focus for general body image concerns, while adults of all ages were considered in palliative care contexts. This broader scope ensured that the review captured youth vulnerability while also reflecting the lived experiences of older adults, whose illness-related body image challenges remain significant. The demographic gap between these groups was acknowledged and intentionally framed as a comparative perspective rather than a limitation. Studies were required to address body image concerns in relation to media influence, cultural beauty norms, physical disfigurement, chronic illness or palliative care. Eligible outcomes included body dissatisfaction, self-objectification, depression, anxiety, self-esteem changes and the efficacy of interventions such as cognitive behavioural therapy (CBT), digital campaigns or narrative-based approaches. Both quantitative and qualitative empirical studies were included, with systematic reviews and meta-analyses considered for background triangulation. Only English-language publications were retained.

Search strategy

The search process followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, drawing on databases including PubMed, PsycINFO, Scopus, Web of Science and Google Scholar, covering studies published between January 2004 and April 2024. Boolean operators combined key terms such as

(‘body image’ OR ‘body dissatisfaction’ OR ‘selfobjectification’) AND

(‘social media’ OR ‘beauty standards’ OR ‘AI filters’ OR ‘digital beauty’) AND

(‘mental health’ OR ‘eating disorders’ OR; ‘depression’ OR; ‘self-esteem’) AND

(‘palliative care’ OR ‘chronic illness’ OR ‘amputation’ OR ‘chemotherapy’ OR ‘scarring’)

Filters were applied to restrict results to English-language publications, human subjects and specific age groups – 10–30 years for general population studies, with all adult age ranges included for palliative care. The search yielded 20,902 initial records, after which duplicates were removed and 8,114 titles and abstracts screened. Of these, 146 full texts were assessed in detail, and 18 studies met all eligibility criteria and were included in the final synthesis. This transparent reporting of search operators, filters and record counts at each PRISMA stage strengthens the reproducibility of the review process.

Study selection and data extraction

Following the PRISMA protocol, the study selection process began with the identification of 20,902 records across databases, after which duplicates were removed using EndNote. Titles and abstracts were then screened independently by two reviewers to ensure alignment with the predefined inclusion criteria, with discrepancies resolved through discussion. Full-text appraisal was subsequently undertaken for all potentially eligible articles, focusing on population, concept, outcomes and study design relevance. At this stage, studies failing to meet criteria were excluded, including those with insufficient methodological detail or low-quality appraisal scores. Ultimately, 18 studies were retained for synthesis.

Data extraction from these studies was conducted systematically using a structured template to ensure consistency and comparability across the final dataset. The extracted information included author(s), year of publication and study location; sample demographics and study design; types of interventions and delivery platforms; psychological outcomes assessed and, where applicable, the underlying theoretical framework guiding the study.

Risk of bias and quality assessment

Risk of bias and study quality were assessed using standardised tools appropriate to each study design. Randomised controlled trials (RCTs) were evaluated with the Cochrane Risk of Bias Tool, while observational studies were appraised with the Newcastle–Ottawa Scale (NOS). Studies achieving a score of six or higher on the NOS or rated as having lowto-moderate risk using the Cochrane tool were retained for inclusion. Those falling below these thresholds were excluded (n = 5), unless they provided unique contextual insights that warranted consideration, in which case their limitations were explicitly annotated during synthesis. To ensure reliability, two independent reviewers conducted all assessments, with disagreements resolved through consensus.

Research questions

This review was guided by six primary research questions. First, it sought to explore how beauty ideals have evolved in the digital era. Second, it examined the impact of media and AI filters on body image. Third, it investigated the psychological effects resulting from body dissatisfaction. Fourth, it considered which interventions are effective in improving body image and mental health. Fifth, it analysed how body image struggles are experienced within palliative care settings. Finally, it assessed which support strategies appear most effective for individuals facing such challenges.

Data collection and synthesis

Extracted data were thematically analysed using NVivo and organised into four overarching domains. These domains included media influence and body image trends; psychological impacts such as anxiety, depression and self-esteem; intervention approaches including CBT, social campaigns and digital tools; and specific challenges related to chronic illness and palliative care.

Quality assessment of studies

Of the 18 studies analysed, 16 clearly articulated their research objectives, and 17 provided transparent reporting of campaign content and implementation. Similarly, 17 studies explicitly defined core campaign components, including target audience, delivery platform and key messages, which enhanced clarity and replicability.

Despite these strengths, several limitations were observed. Only six studies integrated established psychological theories or therapeutic models, such as body image resilience theory or the health belief model, to guide their interventions. Just three employed hypothesis-driven, pre–post intervention designs to rigorously test effectiveness, and only one study met all methodological quality indicators, including sample size justification, use of validated outcome measures and a theory-driven design framework.

While CBT frequently appeared in the broader literature as a recommended approach for addressing body dissatisfaction, none of the included studies implemented or directly evaluated CBT-based interventions. Accordingly, references to CBT have been de-emphasised in the abstract and results to maintain consistency with the evidence, with its role instead positioned in the discussion as a potential direction for future research.

Theme development process and characteristics of campaigns

Themes were identified through inductive thematic analysis, guided by Braun and Clarke’s six-phase framework. Two independent coders analysed the qualitative findings and campaign descriptions, achieving an inter-coder agreement of 92%, with discrepancies resolved through consensus meetings. To enhance rigour, themes were first piloted on five randomly selected studies, refined iteratively and then applied to the full dataset. Although the analysis was primarily inductive, alignment with PRISMA qualitative synthesis guidance was maintained. This process strengthens transparency and credibility in how themes such as body positivity, mental health awareness and illness-related body struggles were derived. Fifteen major body image campaigns from eight countries were identified. Campaigns were categorised based on scope and target population:

• General public campaigns (n = 4) addressing broad societal attitudes

• Targeted campaigns (n = 11) focusing on adolescents, young adults and vulnerable populations, including individuals undergoing physical changes due to medical treatments (e.g., palliative care patients).

Five core themes emerged:

1. Body positivity and self-acceptance (n = 9)

2. Challenging unrealistic beauty standards (n = 6)

3. Mental health awareness and self-compassion (n = 5)

4. Illness-related body image struggles (n = 3)

5. Media engagement strategies such as social media (n = 12), television/print (n = 7), online forums (n = 6) and educational programmes (n = 4).

Outcome evaluation methods

The effectiveness of the campaigns was evaluated using a range of methodological approaches. Twelve studies relied on surveys and validated psychological scales to measure outcomes such as self-esteem, body dissatisfaction and self-objectification. Four studies employed RCT designs to compare intervention and control groups, providing more robust evidence of effectiveness. Five studies incorporated social media analytics, tracking user engagement and shifts in sentiment to capture digital impact. In addition, three studies conducted content analyses of participant responses and discussions before and after campaign exposure, offering qualitative insights into audience reception and change processes.

Impact of body image awareness campaigns

Key findings from the synthesis highlighted several positive outcomes across the included studies. A total of 11 studies reported increased acceptance of diverse body types and a reduction in the internalisation of narrow beauty ideals, suggesting that campaigns emphasising inclusivity were effective in reshaping body image perceptions. Seven studies found that participants demonstrated lower engagement with appearance-centric media content following exposure to interventions, indicating a shift toward more critical media consumption habits. Nine studies documented higher levels of self-compassion, particularly among adolescent girls exposed to body-positive or resilience-focused messaging, underscoring the potential of such approaches for vulnerable groups. In addition, six studies observed reductions in self-objectification and appearance-based self-worth, pointing to meaningful improvements in how individuals evaluated themselves beyond physical appearance. Collectively, these findings indicate that body image awareness campaigns can foster healthier psychological outcomes and challenge harmful societal beauty norms, though the strength of evidence varied depending on study design and methodological quality.

For individuals in palliative care or living with chronic illnesses, campaigns that acknowledged illness-related changes (e.g., hair loss, weight fluctuations, scarring and amputation) were found to significantly improve self-acceptance and emotional resilience. Campaigns featuring testimonial videos, real-life stories and peer narratives were particularly effective in creating emotional resonance and shifting perceptions.

Intermediate impacts and long-term challenges

Short- to intermediate-term behavioural changes were observed across the included studies. Eight studies reported that participants increasingly challenged societal beauty norms and questioned previously internalised ideals, reflecting a more critical stance toward unrealistic standards. Seven studies found evidence of engagement in self-affirmation or mindfulness practices, suggesting that campaigns encouraged the adoption of protective coping strategies. Six studies documented greater help-seeking behaviours for body image or mental health concerns, highlighting an improved willingness to access support. In addition, five studies noted positive shifts in social media behaviour, such as following body-positive influencers, which demonstrated the potential for digital environments to reinforce healthier body image practices.

Despite these encouraging findings, challenges to sustaining long-term impact were evident. Two studies emphasised cultural resistance to body diversity in appearance-driven societies, while one study noted that short-term exposure to interventions was insufficient to significantly alter attitudes among individuals with low self-esteem. Moreover, several digital campaigns identified algorithm-driven exposure to idealised beauty content as a counterforce to campaign messaging. Among palliative care patients, although initial improvements in self-image and emotional well-being were documented, maintaining these effects beyond the campaign period remains a considerable challenge.

Future research should therefore explore strategies to strengthen long-term outcomes. Potential approaches include the integration of community-based peer support groups, the use of digital storytelling and patient-led media to normalise diverse appearances and the development of AI-driven personalisation tools that provide tailored affirmations and real-time support.

Challenges and limitations in addressing body image in palliative care

Despite encouraging findings, several gaps and challenges remain in advancing body image interventions for individuals in palliative care.

Illness-related appearance changes and identity disruption remain a central issue, as patients in palliative contexts experience involuntary physical transformations such as cachexia, alopecia, surgical scarring and prosthetic use, which directly affect body image and identity.^[7] Effective interventions must extend beyond beauty-focused messaging and address the emotional and existential dimensions of bodily change.

Cultural and societal stigma further complicates care. In many contexts, visible markers of illness, disability or ageing are associated with shame, invisibility or social exclusion.^[22] These cultural messages are often internalised, amplifying distress. Campaigns must therefore be culturally sensitive and responsive to religious, familial and collective narratives around illness and appearance.

Short-term relief versus long-term psychological support also represents a major limitation. Most reviewed campaigns were event-based or short-term, leading to only transient improvements in mood and self-perception. Sustained improvements in body image, particularly in the context of degenerative illness, require ongoing engagement through counselling, peer support and adaptive coping strategies.^[14]

Finally, limited longitudinal and palliative-specific research remains a barrier. Few studies explicitly targeted palliative care populations, and longitudinal evaluations were scarce. Much of the current evidence base is drawn from general youth populations, limiting generalisability. This highlights an urgent need for contextualised, longitudinal research on body image in advanced illness.^[22]

Future directions and policy implications

To enhance the sustainability and inclusivity of body image awareness initiatives, future interventions should prioritise integrative, personalised and scalable approaches, particularly for individuals with chronic or terminal illnesses. AI-driven and personalised digital tools hold significant promise. AI-enabled platforms can detect emotional distress through text or voice analysis, deliver personalised self-compassion practices and provide just-in-time psychological prompts. These tools should be developed with input from clinicians and designed with cultural sensitivity.^[26]

Media literacy education in clinical and palliative care settings also holds potential. Structured training for patients, caregivers and healthcare professionals can demystify digital beauty standards, reduce stigma around illness-related body changes and foster critical awareness of appearance-based biases.^[21]

Community-based and peer-led support models further enhance resilience. Peer groups, survivor networks and storytelling platforms offer empathetic validation and reduce isolation. Within palliative care, such models support both patients and caregivers in managing body image-related grief and adjustment.^[27]

Finally, policy and institutional integration are essential. Campaigns should be embedded within public health strategies, hospital communication protocols and educational curricula, promoting body diversity and resilience from early development through end-of-life care. Partnerships with palliative care providers, advocacy organisations and digital platforms are essential to maximise reach and cultural relevance.