The highways along Utah’s Wasatch Front are lined with billboards with slogans like “God is rebuilding His temple. Isn’t it time to rebuild yours?” It’s hard to avoid the advertising campaigns for cosmetic procedures.

Utah residents are also the most likely to search for breast augmentation on Google.

Members of The Church of Jesus Christ of Latter-day Saints, by far the state’s largest group, undergo major cosmetic surgery at higher rates than the average American — 14% among Latter-day Saints compared to 4% nationwide, a new study finds. That includes things like breast augmentation, tummy tucks and liposuction.

And 20% of church members surveyed had undergone cosmetic surgery. The most common procedures were laser hair removal, chemical peels and Botox injections.

The study was published by Utah State University’s Utah Women and Leadership Project and co-authored by Sarah Coyne, a professor of family life at Brigham Young University. She said religiosity tends to lead to better body image, yet she continues to hear from BYU students that they struggle with their body image or have an eating disorder.

“This feels strange,” she thought. “This is a very religious place. Why do I see this over and over again?”

This interview has been edited for length and clarity.

Ciara Hulet: You surveyed more than 1,300 members of The Church of Jesus Christ of Latter-day Saints. What do you think lies behind these statistics?

Sarah Coyne: People who were very religious and had a strong connection to God were less likely to have plastic surgery. On the other hand, “costly grace” is the idea that I have to earn God’s love. Grace is not given for free. And that is not something the LDS Church teaches. I think it is a real misunderstanding of the concept of grace. (People who accepted the concept of costly grace) were more likely to have plastic surgery.

And especially those who had a lot of money and also had a high religious status, for whom religion was very important, were more likely to undergo cosmetic surgery. And we wondered if this was a misunderstanding of perfection or the idea that I have to be perfect in everything I do, and that includes my appearance.

CH: Do you think that church culture influences these numbers?

SC: Yes, I do. And it varies from community to community, community to community. And we’ve found that there are some areas that are really protected. So high acceptance, high diversity – in terms of race, body shape and size, and then also clothing and appearance. And those tend to be wonderful (places) to thrive in terms of body image.

But in other communities, it was a little more difficult. In a culture around plastic surgery, you feel like everyone gets it and everyone talks about it, and that’s the right thing to do. Cultures around judgment or pressure to look your best. That pressure of, “I have to look perfect on a Sunday.” And then that was tied to poor body image. And again, this is not LDS doctrine per se. It’s just kind of the local peculiarity of an individual community.

CH: What impact does a lack of diversity have on body image?

SC: When you live in an area where everyone is very similar, everyone looks the same and everyone dresses the same, we tend to compare ourselves to others much more. And then we are more likely to feel worse.

CH: Do you think that teachings on modesty influence people’s attitudes toward their bodies in the church?

SC: We’ve had very mixed reactions. Some people have said it’s been very positive for them and they’ve felt more comfortable in their bodies and less objectified. Others have been very negative and said they’ve felt frumpy or unattractive. And then there’s the comment that they’ve felt objectified and their appearance has been more of a focus.

CH: Are there different views among members regarding the church’s moral principles?

SC: We asked how they were taught modesty growing up, and we found that it was more principle-based… you know, showing respect for others or for yourself and then showing humility, right? Because you can have a modest home and a modest car and the way you talk, right? So modesty is not just about how women dress. When it was taught to them (in a principled) way, it was actually linked to better body image.

But when (modesty) was really taught in a hands-on way, so the focus was really on hem lengths or, you know, things like that, (it was associated with poor body image.) And then especially when they felt objectified. So, you know, when they said, “Hey, you know, you have to be modest to protect men’s opinions.”

CH: So what are your recommendations from this work?

SC: I really like what the church is doing with modesty and dress. They updated the For the Strength of Youth guidelines to be more principle-based and more of a conversation between you and God. And I think it’s moving a little bit away from the rhetoric that we’ve heard for years. I just hope that’s now becoming part of the church culture, right? It’s going to be a difficult adjustment.