Dieting and regular exercise are often framed as clear signs of good health. But new research suggests that when those behaviors become tightly linked to identity, appearance and self-worth, they may carry mental health risks that aren’t immediately visible.
A population-based study led by researchers at University of Warwick and published in Current Psychology found that teenage girls of “normal” weight who engaged in constant body management were more likely to experience anxiety, depression and psychological distress by age 20.
The study focused on young women who maintained their weight through strict regimes of diet and exercise. Rather than food restriction alone, these behaviors were characterized by “clean eating,” fitness routines and ongoing self-monitoring. Although these young women often appeared healthy by conventional standards, many reported weight stigma, high levels of anxiety-related traits and thoughts of self-harm and suicide.
By age 20, this group was more likely to report symptoms associated with anxiety and depression, poorer psychological wellbeing and elevated distress compared with peers who did not engage in the same level of body-focused management.
The findings challenge the assumption that dieting and exercise are always straightforward indicators of health. Instead, the researchers argue that body management has increasingly become tied to social value and personal identity, particularly for young women navigating image-driven environments.
“In an image-saturated culture, young women are praised for being fit and slim,” said Dr. Dimitra Hartas, Reader at the University of Warwick and lead author of the study. “But beneath this veneer of health lies a troubling reality. For many, managing body weight is not about wellbeing — it is about meeting cultural expectations and earning a sense of worth.”
The study situates these behaviors within a broader social context, where health is often equated with appearance and where self-optimization is treated as a moral responsibility. In this environment, body satisfaction can function as a form of social currency, shaping how young women perceive their value and how they believe they are judged by others.
“This pressure for the female body to shrink is a form of social control,” Hartas said. “It restricts women’s physical and symbolic space, shaping how they see themselves and how society permits them to exist. The mental health cost of this pressure is significant and too often overlooked.”
The researchers note that these findings align with wider trends in youth mental health. Recent data show that around one in three women aged 16 to 24 report experiencing mental ill health, and rates of self-harm among young women have risen sharply over the past two decades.
The authors argue that recognizing body-focused young women of normal weight as a vulnerable group is critical for prevention and support efforts. Hartas said that health messaging needs to move beyond appearance-based measures and weight alone.
“Health messaging needs to move beyond weight and appearance,” she said. “We need to ask not just how young women look, but how they are actually doing — psychologically, emotionally and socially.”
Dr. Michael C. Watson of the Institute of Health Promotion and Education, who was not involved in the study, said the findings underscore the need for broader approaches to youth health.
“We need to move beyond BMI and weight management towards promoting exercise, sleep and healthy eating, while also tackling body image and fat shaming,” he said. “This is a complex challenge that won’t be solved by one-off or isolated interventions.”
The researchers emphasize that the study is observational and cannot establish cause and effect. Still, the findings add to growing evidence that health behaviors shaped by pressure, stigma and constant self-surveillance may undermine wellbeing, even when they align with conventional ideals of “healthy living.”
No funds, grants or other support were received for this study.