Long-term insights: Seven years of conservative management for deep endometriosis in the bowel.

Body image (BI) is a multidimensional psychological concept that encompasses the many ways people view, feel, and respond to their bodies. It exists along a continuum from largely accurate and positive perceptions to distorted and predominantly negative ones. Developmentally, early adolescence represents a critical period for body image formation. A recent meta-analysis reported that between the ages of 10–16, body image tends to worsen among adolescent girls while improving among boys, with the most pronounced changes occurring between ages 10–12. During this period, body image becomes increasingly shaped by external influences, with peers and media playing particularly salient roles in shaping appearance ideals, social comparison, and self-evaluation. In addition to these sociocultural influences, physical activity is an important yet complex factor in adolescent body image development. Engagement in physical activity is generally associated with more positive body image, greater body satisfaction, and improved psychosocial outcomes when experiences emphasize enjoyment, competence, and embodiment rather than appearance-based outcomes. However, physical activity contexts can also reinforce body surveillance, social comparison, and performance anxiety, particularly for adolescent girls navigating heightened peer evaluation in movement spaces. These dynamics are especially relevant during middle school years, when physical activity enjoyment often declines and participation becomes increasingly influenced by social and psychological factors. These considerations are particularly important for Black adolescent girls, whose body image experiences are shaped by both mainstream sociocultural pressures and culturally specific norms related to body shape, skin tone, hair, and identity. Emerging research suggests that Black girls may, on average, report higher body satisfaction than their White peers, yet these findings are often interpreted in the absence of sociocultural context. Black girls’ body image experiences are complex, culturally grounded, and shaped by intersecting systems of race, gender, and appearance-based expectations. For example, culturally specific factors such as hair texture, skin tone, and body shape are central to body image among Black adolescent girls, with satisfaction in these domains strongly associated with overall body esteem. Simultaneously, Black girls must navigate dominant Eurocentric beauty standards, colorism, and limited representation in media, which can contribute to appearance-based pressure and identity-related stress. Racial and ethnic identity has also been identified as a potential protective factor, buffering against negative body image by reinforcing alternative standards of beauty and self-worth. For example, among Black adolescent girls, stronger racial-ethnic identity has been associated with greater resistance to Eurocentric beauty standards and reduced internalization of appearance-related messages that stigmatize Afrocentric features such as skin tone, hair texture, and body shape. Similarly, ethnic-racial identity commitment has been linked to lower levels of appearance-based concerns and depressive symptoms among Black adolescents, suggesting that a strong sense of racial identity may serve as a buffer against the psychological harms of racialized beauty ideals. Taken together, this body of research suggests that Black girls’ body image is culturally constructed, requiring approaches that are culturally responsive and identity-affirming. However, few interventions explicitly address these culturally specific dimensions when aiming to leverage physical activity, limiting their ability to promote positive body image in affirming and psychologically safe environments.