Throughout history, women have been expected to meet a certain body image in line with the contemporary standard of appearance and beauty, usually determined by male views. Preoccupation with body image was heightened at the turn of the century with the greater availability of mirrors in private and public spaces and the development of photography. Interest was intensified with the growth of photography through the 20th century, and with the advent of television, motion pictures, and, more recently, the Internet. The idealized female body shape has transitioned from corsets and narrow waists in the 19th century to natural shapes in the early 20th century, the svelte look in the 1920s, and fuller busts and rounded hourglass figures in the 1930s. During the era of short hemlines of the 1960s and 1970s, increasing attention was focused on the size and shape of women's thighs and buttocks.
The link between changes in body look and fashion is evident through many examples. For example, the desired image of a fuller bust gave way to breast augmentation surgery, which was achieved through the insertion of silicone breast implants. These procedures are associated with a number of complications, including infection, bleeding and leakage of silicone, and even a systemic illness. Concern about thigh size fueled efforts to develop cellulite-fighting creams and liposuction to remove fatty tissue.
Other items that were thought to enhance body image but actually had potentially harmful effects include "beauty products" for makeup, hair coloring, and footwear. The use of hair and facial products may be associated with eyelid inflammation, chemical burns, and hair loss. Nail salons have been identified as a potential site for the transmission of various infectious agents, including hepatitis B and C, and HIV; transmission can be avoided through the use of proper techniques for sterilizing instruments. A greater proportion of women wear shoes smaller than their feet, and many develop arthritic changes over the years as a result of damage caused by shoes. Narrow toe-boxes in shoes can exacerbate joint problems such as bunions and hammertoes; 90% of surgeries in women are performed to correct these. High heels can be responsible for a number of health problems as a result of alterations in the normal function of the ankle and changes in the ability to maintain balance. These include increased risk of injury due to falls, low back pain due to compensatory reliance on different parts of the musculoskeletal system to achieve balance, and osteoarthritis of the knee.
Body image has also been implicated in the ever-increasing rates of eating disorders in the 20th century, from self-abasement, to binge eating. The creation of the Barbie doll in 1959, setting an unrealistic standard of beauty, has been blamed for encouraging girls to adopt unhealthy habits in an attempt to achieve that body image. An estimated 5–10 million women were identified with such disorders in the 1990s, with the prevalence believed to be higher among white, middle-class, educated young women, possibly due to differences in standards of beauty and body image. However, some argue that eating disorders may be underreported among women of color.
Since the late 1970s, preference for body image has shifted to a more athletic look, with an increase in the number of women participating in sports and regular exercise, emphasizing a healthy lifestyle. The female population is growing larger and significantly heavier in body weight, with high rates of obesity in the United States and elsewhere in the world, and women are increasingly seeking an image that is both healthy and realistic. Obesity and lack of exercise have been identified as some of the most important modifiable risk factors for CVD and cancer, the two leading causes of mortality in women. On the more positive side, considerations for body image became a catalyst for reconsidering radical mastectomy for the treatment of breast cancer. This procedure, developed by William Halsted in 1915, remained the standard of care until 1985, when lumpectomy (removal of the lump) combined with radiation therapy was shown to be as effective as radical mastectomy.
