What is and what is not positive body image? Conceptual foundations and construct definition

Development and Psychometric Properties of the Self-Acceptance Scales for Pregnant and Postpartum Women

Self-acceptance, that is, a person's acceptance of their own psychological and physical attributes, is considered critical for mental wellbeing. A lack of self-acceptance may contribute to the development of psychopathology. In the peripartum period, self-acceptance has particular relevance, as major psychological and body changes are normative during this time. This research presents the development and validation of the Self-Acceptance Scale for Pregnant Women (SAS-PW) and the Self-Acceptance Scale for Postpartum Women (SAS-PPW). Participants were aged 18-52. In Study 1, we developed 77 items for the SAS-PW and 74 items the SAS-PPW, based on literature review, previous scales, and qualitative study. In Study 2, nine experts and 60 representatives of the target population evaluated the instruments' content validity, leading some items to be excluded and others to be modified. Studies 3 and 4 analyzed the instruments' psychometric qualities among respondents to the instruments, 1254 pregnant women and 607 postpartum women from across Brazil. We conducted exploratory and confirmatory factor analyses with independent samples. The final SAS-PW (10 items and two-factors) and SAS-PPW (14 items and three-factors) demonstrated adequate psychometric quality for use with Brazilian pregnant and postpartum women, respectively.

Mumbod? A comparison of body image and dietary restraint among women with younger, older, and no children

Pregnancy and the postpartum period are times of significant body, and body image changes for women. Adult women (N = 885) aged 21 to 47 years old completed an online questionnaire. Mothers of young children (0-5 years) had significantly lower levels of body shame, self-objectification, and dietary restraint than women without children, and women with school-aged (6-10 years) children had significantly lower self objectification than women without children, once we controlled for age. BMI predicted body shame more than motherhood status. This research has implications for the development of appropriate body image interventions for adult women.

A comprehensive model of disordered eating among aesthetic athletic girls: Exploring the role of body image-related cognitive fusion and perfectionistic self- presentation

The incidence of disordered eating among athlete populations is considerably higher than in the general population. Less well understood is the body image-related emotional processes that might lead to disordered eating attitudes and behaviours, specifically among aesthetic athletic girls. Thus, the aim of the present study was to explore the role that body image-related cognitive fusion plays in disordered eating, and the mediating role of body image-related perfectionist self-presentation on this relationship, in aesthetic athletic girls. This study comprised 142 young female athletes from aesthetic sports, who completed self-report measures. A path analysis was conducted to explore the proposed theoretical model, while controlling for age and zBMI. The path model revealed an excellent fit and explained 71% of the severity of disordered eating. Results showed that body image-related cognitive fusion influences disordered eating behaviours, through the mechanism of body image-related perfectionist self-presentation, even when controlling for age and zBMI. Findings suggested that, in aesthetic athletic girls, the entanglement in body image-related thoughts may be associated with the need to present a perfect body image to others, which may lead to disordered eating attitudes and behaviours, adopted as a means to control weight and body shape. The present study highlights the relevance of body image-related processes in disordered eating and suggests the importance of educational programmes that target the development of more adaptive emotion regulation strategies concerning body image in athletes, particularly from aesthetic sports.

"I'm actually pretty happy with how I am": a mixed-methods study of young women with positive body image

OBJECTIVE

Previous research on body image has tended to overlook what contributes to positive body image. The aim of the present study was to explore the perspectives of female undergraduate students with positive body image.

DESIGN

Nineteen young women who were studying at a New Zealand university (mean age 19.61) and self-reported positive body image participated in focus groups discussing body image.

MAIN OUTCOME MEASURE

Thematic analysis resulted in four themes.

RESULTS

The young women described a positive shift in body image that occurred between adolescence and early adulthood (theme 1). They were critical of messages about the female body within media and made conscious decisions about media they engage with (theme 2). They expressed a functional conceptualisation of their bodies and had strategies for responding to negative thoughts and feelings (theme 3). Religious and cultural identity played a specific role in body positivity for some participants (theme 4).

CONCLUSION

These findings highlight the developmental nature of positive body image and the role of adopting critical awareness when engaging with media. The findings support and elaborate on previous research suggesting that those with positive body image utilise a body-protective filter and demonstrate novel aspects of young women's body positivity.

Bulimic symptoms in a sample of college women: disentangling the roles of body size, body shame and negative urgency

Purpose This study set out to disentangle the roles of body size, body shame and negative urgency on bulimic symptomatology in a sample of college women. We predicted that body shame would mediate the relationship between body size and bulimic symptomatology: with increasing body size, the greater would be the experience of body shame and, in turn, the greater the bulimic symptomatology. We also predicted that negative urgency would exacerbate this mediation pathway, and that the moderated mediation model would occur over and above current levels of depression.

METHOD

A convenience sample of 237 college women indicated their age, height and weight and then completed measures of body shame, negative urgency, depression and bulimic symptomatology. Bootstrap analysis was used to test the predicted moderation mediation model.

RESULTS

The bootstrap analysis supported all predictions. Thus, with greater the increase in body size, the greater was the body shame and the more frequent bulimic symptomatology. Furthermore, negative urgency moderated the relationship between body shame and bulimic symptomatology, such that those with both higher negative urgency and body shame had more frequent bulimic symptomatology.

CONCLUSIONS

Results suggest that those college women higher in both BMI and negative urgency are likely to experience higher levels of bulimic symptoms. These women may benefit from emotion regulation interventions targeted at preventing, as well as coping effectively with, the experience of body shame.

LEVEL OF EVIDENCE

V: cross-sectional descriptive study.

Body Dissatisfaction as a Mediator between Identity Formation and Eating Disorder Symptomatology in Adolescents and Emerging Adults

Objective:

Eating disorder symptomatology generally develops during adolescence and emerging adulthood. Previous research has focused on the role of identity formation or body image in the development of eating disorder symptomatology, but integrative work is lacking. For this reason, the present cross-sectional study examined the mediating role of body dissatisfaction in the relation between identity formation and eating disorder symptomatology.

Method:

The sample comprised 659 participants between 15 and 30 years old (68.9% females; M_age = 19.44; SD_age = 3.99). All participants completed self-report measures on identity (Self-concept and Identity Measure), body dissatisfaction (the Body Image Feelings and Attitudes subscale of the Body Investment Scale and the Body Dissatisfaction subscale of the Eating Disorder Inventory-3), and eating disorder symptomatology (Eating Disorder Inventory-3). Latent variable modeling from a structural equation modeling approach was used.

Results:

First, identity formation significantly predicted eating disorder symptomatology. Additionally, indirect effects were found linking identity formation to eating disorder symptomatology through the mechanism of body dissatisfaction. No significant differences between males and females or between adolescents and emerging adults on direct or indirect effects were found.

Conclusion:

The present study indicated that body dissatisfaction mediated the relationship between identity formation and eating disorder symptomatology during mid-to-late adolescence and emerging adulthood. Provided that the present findings can be replicated in a future longitudinal study, they demonstrate that both identity formation and body dissatisfaction should be taken into account in prevention and intervention programs targeting eating disorder symptomatology.

Body Image Relates to Exercise-Induced Antinociception and Mood Changes in Young Adults: A Randomized Longitudinal Exercise Intervention

Background: An important motivation for adolescents and young adults to engage in aerobic exercise (AE) is to improve fitness, body composition and physical appearance. These parameters have an impact on bodily perception as conceptualized by the 'body image' (BI) construct. AE is known to have positive effects on pain perception, mood, and body image (BI). However, no study has hitherto investigated their interrelationship within one study. Methods: Participants were randomly assigned to an intervention group (IG, n = 16, 6 months of AE) or a passive control group (CG, n = 10). Frankfurt Body-Concept Scales (FKKS), Positive and Negative Affect Scale (PANAS), State and Trait Anxiety Inventory, warmth and heat pain thresholds (WPT, HPT), pain tolerance, and graded exercise test data from baseline (T0) and the end of the intervention (T6) were analyzed using a paired t-test (p < 0.05). Results: A significant increase in the BI dimension 'physical efficacy' was identified from T0 to T6, which correlated positively with PANAS Positive Affect Scale and HPT. Conclusion: Data in young adults undergoing AE indicate that changes in the BI sub-category 'physical efficacy' are closely linked with changes in positive affect and antinociception. These novel findings suggest that BI plays a role in antinociception and positive affect.

Building resilience to body image triggers using brief cognitive training on a mobile application: A randomized controlled trial

OBJECTIVE

Body image disturbance (BID) is common among women, characterized by persistent and distressing appearance dissatisfaction, and linked with eating disorders. Although effective, cognitive behavioral therapy (CBT) delivered by trained professionals is not easily accessible. This randomized trial evaluated the effects of a CBT-based mobile application designed to increase resilience to body image triggers and reduce BID symptoms.

METHOD

A non-clinical sample of women (N = 90; M_age = 23.52) was randomized to use the mobile application for approximately 4 min of daily exercises for two weeks or to a control condition. Body image was measured at baseline, immediately after two weeks of mobile application use, and at 1-month follow-up. To examine whether using the application was associated with increased resilience to common BID triggers, participants completed an Instagram exposure resilience task upon completion and at 1-month follow-up.

RESULTS

Relative to those in the control condition, participants who used the application demonstrated increased resiliency and reduced BID symptoms. Theses effects were medium-to-large and were maintained at 1-month follow-up.

CONCLUSION

These results underscore the potential usefulness of brief, low-intensity, portable interventions in reducing BID symptoms and in increasing resilience to thin-ideal body messages often portrayed on social media.

I (DON'T) LOVE MY BODY: COUNTER-INTUITIVE EFFECTS OF A BODY-AFFIRMING STATEMENT ON COLLEGE WOMEN'S BODY SATISFACTION

Introduction: Messages encouraging women to love their bodies are common elements of positive body image movements, but there are theoretical reasons to suspect that such messages may backfire.

Methods: In a sample of 293 college women, we tested the impact of mentally repeating the affirmation “I love my body” on body satisfaction. We prompted participants to think either “I love my body” (affirmation condition) or “I am [age] years old” (control condition) while they completed a five-minute writing task.

Results: Relative to the control, the affirmation condition led to significantly lower body satisfaction. Additionally, 53% of affirmation condition participants counterargued the body affirmation by writing something negative about their appearance; only 6% in the control condition wrote a negative appearance comment.

Discussion: Results suggest that some messages intended to promote positive body image have the potential to decrease women's body satisfaction, in part because they prompt women to think of flaws in their appearance.

An examination of older men's body image: How men 65 years and older perceive, experience, and cope with their aging bodies

We examined how older men perceived, experienced, and coped with age-related changes to their appearance, body function, and health. Data from semi-structured interviews with 28 men aged 65-83 living in a large urban Canadian city and diverse in ethnocultural background (European, East Asian, and South Asian) and sexual orientation (heterosexual and gay) were analyzed through a reflexive thematic analysis. Four overarching themes were constructed from the participants' accounts. Participants were ambivalent about their aging bodies; they were concerned about certain changes to their bodies, yet concurrently grateful for their retained health and body function. The men stressed the need to accept age-related body changes through pragmatism, awareness of challenging body-related cognitions and emotions without overidentification or suppression, and adjustments to expectations and activities. Participants engaged in upward and downward social comparisons to assess their aging bodies in relation to others and to their younger selves. Weight concerns were prominent. The men worried about their weight, with particular attention to their stomach, and were physically active and ate a healthy diet to manage their weight. This study contributes to body image theorizing by including older diverse men and can inform interventions aiming to enhance men's later life psychological adjustment.

The association between body appreciation and body mass index among males and females: A meta-analysis

To date, a number of studies have reported an association between body appreciation and body mass index (BMI), but the findings are not consistent. Using a meta-analytic approach, the current study aimed to clarify this association as well as to explore what factors might have contributed to the inconsistency across previous studies. By searching and screening potential studies published up to June 2019 in four databases, we identified 26 articles that reported an association between body appreciation and BMI among males, and 59 articles among females. Under a random-effects model, among males the overall estimate of the association between body appreciation and BMI was negative and small, with the pooled r = -.20 (95 % CI: -.25, -.14) and an adjusted (for publication bias) pooled r = -.11 (95 % CI: -.16, -.06). Among females, the overall estimate of the association was negative and small (but close to moderate), with r = -.27 (95 % CI: -.30, -.24). A mixed-effects model identified several moderators that contributed to the inconsistency across previous studies. These results indicate that the overall negative association between body appreciation and BMI is weak among males, and slightly larger among females. Potential explanations, implications, and future research directions are discussed.

Body Image and Sexual Behavior Among Adult Men Who "Hook Up"

Understanding the psychosocial variables associated with sexual behavior is critical, particularly among high-risk individuals such as those who hook-up. It is possible body image is one of these variables. The current study aimed to examine the relationship between body appreciation and body image self-consciousness and three sexual health-related behaviors: 1) condom usage, 2) HIV screening, and 3) STI screening among a sample of adult men who have hooked up at least once in the past month (n = 243). We found that higher levels of body appreciation were related to being less likely to use condoms and higher levels of body image self-consciousness were related to being less likely to be screened for HIV and STIs. The conflicting results suggest additional research is warranted.

Examining the factor structure, sex invariance, and psychometric properties of the Body Image Acceptance and Action Questionnaire and the Functionality Appreciation Scale

Body image flexibility and functionality appreciation are two facets of positive body image gaining significant research attention. The measures that assess these constructs- the Body Image Acceptance and Action Questionnaire (BI-AAQ) and Functionality Appreciation Scale (FAS), respectively-have produced a unidimensional structure with adequate psychometric properties. However, the cross-sex invariance of the BI-AAQ has yet to be established, and replicating the FAS' one-factor structure is needed. We examined the factor structure, cross-sex invariance, and psychometric properties of the BI-AAQ and FAS. Data were analyzed from 383 men and 631 women who completed questionnaires (participants were not restricted to a specific country). An unacceptable model fit for the BI-AAQ was found for men and women, indicating that the unidimensional structure was not replicated. The unidimensional structure of the FAS and an abbreviated 5-item BI-AAQ was replicated, and tests of measurement invariance between men and women were upheld. Evidence of internal consistency, convergent validity, and incremental validity for the abbreviated BI-AAQ and FAS was found. Overall, the abbreviated BI-AAQ and the FAS appear to be psychometrically sound measures of positive body image. Findings suggest that sex comparisons on the abbreviated BI-AAQ and FAS are permissible.

Preliminary development of an implicit association test to measure body dissatisfaction and predict disordered eating behaviors

We conducted a preliminary test of a novel implicit association test for body dissatisfaction (BD-IAT). We predicted that BD-IAT would correlate with self-reported BD and predict later eating disorder (ED) attitudes. Female undergraduates (N = 145) self-reported BD and ED attitudes. In the BD-IAT, participants sorted words related to "satisfaction" and "dissatisfaction" to opposite sides of a computer screen. Participants categorized pictures of themselves to the side of the screen with the word "Me," which appeared with the "satisfied" or "dissatisfied" category in separate blocks. The BD-IAT measured the strength of the association between a participant's own body and dissatisfaction. The BD-IAT correlated positively with the EDI-BD (r = 0.21, p < 0.05), supporting its convergent validity. The BD-IAT predicted ED attitudes at one-week follow-up, controlling for explicit BD and baseline ED (b = 0.58, SE = 0.23, t = 2.57, p = .01); IAT scores uniquely accounted for 4.7 % of the variance in ED at one-week follow-up. These results provide preliminary evidence for the BD-IAT as an implicit measure of BD and suggest that it may predict future ED attitudes above and beyond explicit BD. Directions for future work aimed at continued development of this task are discussed.

An examination of the factor structure and preliminary assessment of the psychometric properties of a Hebrew translation of the Body Appreciation Scale-2 (BAS-2)

The Body Appreciation Scale-2 (BAS-2) is a widely-used, 10-item measure of a core facet of positive body image. To extend its use internationally, we examined the factor structure and conducted a preliminary assessment of the psychometric properties of a novel Hebrew translation of the BAS-2. A sample of 613 Israeli adults (362 women, 251 men; age M = 29.52, SD = 9.47) completed the BAS-2 alongside demographic items and previously-validated measures of life satisfaction, self-esteem, self-compassion, and body investment. Exploratory factor analyses with a semi-random split-half subsample (n = 377) indicated that BAS-2 scores reduced to a single dimension with all 10 items. This factor structure was equivalent across women and men. Confirmatory factor analysis (CFA) with a second split-half subsample (n = 235) showed the 1-dimensional factor structure had adequate fit following one modification and multi-group CFA showed that the model was invariant across sex. Men had significantly higher BAS-2 scores than women, but the effect size was small (d = 0.22). Evidence of construct validity was demonstrated through positive associations with indices of life satisfaction, self-esteem, self-compassion, and body investment. The availability of a validated BAS-2 Hebrew translation should advance future research of body appreciation in Israel.

Are We There Yet? Progress in Depicting Diverse Images of Beauty in Instagram's Body Positivity Movement

As the literature on the narrowly defined standards of beauty portrayed in social media has increased, a newer focus on body positivity messages has also emerged. Body positivity challenges the unrealistic standards of beauty present in the media by the promotion and acceptance of diverse body sizes and appearances. In an effort to further understand the messages of body positivity in social media, this study examined the content of 246 body positive posts from the broad Instagram community. Results demonstrated an inclusion and appreciation of diverse physical appearances, as well as themes consistent with messages promoting body positivity. In contrast to content on popular body positivity accounts, several of the posts from the broader Instagram community did, however, contain contradictory messages, such as the promotion of weight loss or the praise of extreme thinness. Future research examining such contradictory messages in body positivity posts and their effects on body image and other related domains is warranted.

The effects of yoga on functionality appreciation and additional facets of positive body image

This study investigated the effects of yoga on functionality appreciation, and the potential mechanisms that could explain the impact of yoga on additional facets of positive body image. Young adult women (N = 114; M_age = 22.19) were randomised to a 10-week Hatha yoga programme or waitlist control group. Participants completed measures of functionality appreciation, body appreciation, body compassion, appearance evaluation, self-objectification, and embodiment at Pretest, Midtest, Posttest, and 1-month Follow-Up. Follow-up data could not be analysed due to high levels of attrition. The remaining data showed that, compared to the control group, women in the yoga programme experienced lower self-objectification at Midtest and greater embodiment over time. Further, all participants experienced improvements in body appreciation, body compassion, and appearance evaluation over time, regardless of their assigned group. Lower self-objectification contributed to improvements in body appreciation and body compassion. In addition, greater embodiment contributed to improvements in body appreciation, body compassion, and appearance evaluation. Contrary to our expectations, yoga did not lead to increased functionality appreciation, nor was functionality appreciation a mediator of the impact of yoga on positive body image. Instead, lower self-objectification, and greater embodiment, drove improvements in positive body image.

Consumer warning versus systemic change: The effects of including disclaimer labels on images that have or have not been digitally modified on body image

Two strategies for protecting body image against the negative effects of exposure to idealized media images have been proposed: (1) using labels to alert viewers to digital retouching, (2) limiting digital retouching. This study investigated the effects digitally modified vs.unmodified images and the use of labels on those images (disclaimer/retouch-free] vs. unlabeled) on appearance satisfaction and mood. Trait upwards appearance comparison, media ideal internalization, media similarity, and body appreciation were explored as moderators. Participants (n = 614, women, 18-30 years) viewed the same ten images of female figures (both thin ideal and size/shape diverse images) across four conditions: (1) unmodified, unlabelled, (2) unmodified, labelled, (3) modified, labelled, and (4) modified, unlabelled images. Exposure to unmodified images was shown to be less harmful than exposure to modified images. Neither label type was associated with more positive outcomes compared to their counterpart unlabelled conditions. State appearance comparison was highest in the two labelled conditions. Trait upwards appearance comparison and media ideal internalization to some extent moderated effects on negative mood. Findings provide additional evidence that disclaimer labels on digitally modified images are not helpful for body image, while images that depart from the thin-ideal can contribute to promoting positive body image.

Sexual function in hook-up culture: The role of body image

Hook-up mobile apps are increasing in popularity and research suggests sexual function may be lower among those who hook-up compared to those who have sex in a longer-term relationship. Sexual function is an important predictor of well-being; however, we know little about the psychosocial antecedents of sexual function, such as body image, among those who use hook-up apps. The current study aims to examine two measures of positive body image and one measure of body image self-consciousness during intimate activity among a sample of adult women and men who have hooked up in the previous month using a hook-up mobile app (N = 243). Our results suggest that higher body image self-consciousness during intimate activity was related to lower sexual function composite score and several specific domains (i.e., pain, arousal, orgasm, and lubrication) among women. Higher body appreciation was related to higher sexual satisfaction among women. Higher body image self-consciousness during intimate activity was related to higher erection difficulty, but not ejaculation difficulty, among men. These findings highlight the nuanced nature of body image and sexual function and provide further evidence that interventions for women and men aiming to improve some body image constructs may improve sexual function as well.

Does a Facebook-enhanced Mindful Self-Compassion intervention improve body image? An evaluation study

This study evaluates a brief intervention aimed at improving body image. The intervention comprised a Mindful Self-Compassion workshop complemented by a group discussion on Facebook. Young women (M_age = 18.31), screened for body concerns, were allocated by university campus to a 50-minute workshop intervention (n = 42) or a waitlist control (n = 34). Following the workshop, participants in the intervention group utilized self-compassion techniques when experiencing appearance distress and posted about their experiences on a private Facebook group three times per week for two weeks. Findings showed that, relative to control, the intervention group experienced lower upward appearance comparison, social appearance anxiety, body dissatisfaction, and drive for thinness, and higher body appreciation and self-compassion, at posttest and 1-month follow-up. All effects, except those for body dissatisfaction, were held at 3-month follow-up. Additionally, common humanity predicted gains in body appreciation from pretest to posttest. The Mindful Self-Compassion intervention involving a Facebook group may have resonated with young women as it allowed them to share moments of self-compassionate body image experiences in a private and supportive environment.

Cross-cultural measurement invariance of the Body Appreciation Scale-2 across five countries

The Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a, 2015b) is a widely used measure of positive body image within many cultures and countries; yet, cross-cultural examinations are few. The present study aimed to investigate the measurement invariance of the BAS-2 across adults from five countries: Iran, Japan, Poland, Serbia, and the U.S. The sample included 2944 participants ranging in age from 18 to 82 years. The findings provided evidence that the BAS-2's one-dimensional structure is the same in these countries. Partial metric invariance (when some but not all items contribute to a latent construct equally for groups) indicated that nine out of 10 items contributed to the latent body appreciation construct to a similar degree across the countries. When a Multiple Indicators Multiple Causes (MIMIC) model was applied with participants' age and gender as covariates, evidence of differential item functioning was found. Results suggest that both age and gender influenced body appreciation, indicating that the body appreciation factor means are different at different levels of the covariates. In conclusion, cross-culturally body appreciation may be shaped by country, language, age, and gender correlates to different degrees. In future research, measurement invariance analyses should be conducted prior to cultural group comparisons on the BAS-2.

Taking it apart and putting it back together again: Using Item Pool Visualisation to summarise complex data patterns in (positive) body image research

Issues of construct commonality and distinguishability in body image research are typically addressed using structural equal models, but such methods can sometimes present problems of interpretation when data patterns are complex. One recent-developed tool that could help in summarising complex data patterns is Item Pool Visualisation (IPV), an illustrative method that locates item pools from within the same dataset and illustrates these in the form of single or nested radar charts. Here, we demonstrate the utility of IPV in visualising data patterns vis-à-vis positive body image. Five-hundred-and-one adults from the United Kingdom completed seven widely-used measures of positive body image and data were subjected IPV. Results demonstrated that, of the included measures, the Body Appreciation Scale-2 provided the closest and most precise measurement of a core positive body image construct. The Functionality Appreciation Scale and the Authentic Pride subscale of the Body and Appearance Self-Conscious Emotions Scale tapped more distal aspects. Our results also highlight possible limitations with the use of several other instruments as measures of positive body image. We discuss implications for research aimed at better understanding the nature of positive body image and interpreting complex data patterns in body image research more generally.

Intuitive eating and body appreciation in type 2 diabetes

Our objective was to explore the socio-demographic, clinical, and nutritional factors of body appreciation in type 2 diabetics. This is a cross-sectional observational study with 179 adults and older adults (60 ± 10 years old). Most of the sample was female (n = 133; 74.3%). Through logistic regression analysis, it was observed that being perceived as overweight was associated with a 91.6% lower chance of being satisfied with one's body. Trusting hunger and satiety cues doubled the chances of body satisfaction. Thus, eating more intuitively, attending to the signs of hunger and satiety, is associated with greater body satisfaction in type 2 diabetics.

Adolescent body image: influencing factors and the clinician's role

PURPOSE OF REVIEW

Body image is a crucial part of adolescent development for teens all over the world. Studies show that negative body image impacts many aspects of adolescent health and that anticipatory guidance about body image is important at the annual health maintenance exam visit. Weight bias is closely tied to body image and is associated with negative health effects as well; research shows weight bias is a problem throughout healthcare. The purpose of this review is to discuss influencing factors on adolescent body image and to explore interventions to promote positive body image.

RECENT FINDINGS

Research shows that adolescent body image is shaped by media influence, athletics and personal relationships. Studies have also begun to show that negative and positive body image are separate entities, and that overall health outcomes seem to be better in adolescents with positive body image. In thinking about intervention, there are ways to promote positive body image in the provider--patient interaction, within the school and community, in healthcare education, and at the societal level.

SUMMARY

Body image is an incredibly important aspect of adolescent health, and clinicians should be aware of ways to help promote positive body image in adolescents.

Body appreciation and intuitive eating in eating disorder recovery

OBJECTIVE

Eating disorder recovery research has emphasized the absence of symptoms over the presence of adaptive aspects like positive body image and healthy eating attitudes. The current study examined how body appreciation and intuitive eating related to eating disorder recovery using a comprehensive recovery definition (physical, behavioral, and cognitive recovery).

METHOD

Data were collected from 66 women with an eating disorder history and 31 controls with no history of eating pathology. Participants completed an online survey followed by a phone interview.

RESULTS

The fully recovered group did not differ from controls on body appreciation, with both groups endorsing significantly higher levels of body appreciation than the partially recovered and current eating disorder groups. Similarly, the fully recovered group did not differ from controls on overall intuitive eating, with both groups endorsing significantly higher levels of overall intuitive eating than the partially recovered and current eating disorder groups.

DISCUSSION

Positive psychological constructs such as body appreciation and intuitive eating relate to eating disorder recovery status. Understanding recovery within a strengths-based framework may inform intervention and relapse prevention.

Body Image Quality of Life Inventory: cross-national study in college students from four different countries

PURPOSE

This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students.

METHODS

A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one's quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch's ANOVA and the Games-Howell post-test (α = 5%).

RESULTS

CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples, despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores.

CONCLUSIONS

The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students' perceived quality of life. This model must be further tested in other populations.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport

Identification, evaluation and management of disordered eating (DE) is complex. DE exists along the spectrum from optimised nutrition through to clinical eating disorders (EDs). Individual athletes can move back and forth along the spectrum of eating behaviour at any point in time over their career and within different stages of a training cycle. Athletes are more likely to present with DE than a clinical ED. Overall, there is a higher prevalence of DE and EDs in athletes compared with non-athletes. Additionally, athletes participating in aesthetic, gravitational and weight-class sports are at higher risk of DE and EDs than those in sports without these characteristics. The evaluation and management of DE requires a cohesive team of professional practitioners consisting of, at minimum, a doctor, a sports dietitian and a psychologist, termed within this statement as the core multidisciplinary team. The Australian Institute of Sport and the National Eating Disorders Collaboration have collaborated to provide this position statement, containing guidelines for athletes, coaches, support staff, clinicians and sporting organisations. The guidelines support the prevention and early identification of DE, and promote timely intervention to optimise nutrition for performance in a safe, supported, purposeful and individualised manner. This position statement is a call to action to all involved in sport to be aware of poor self-image and poor body image among athletes. The practical recommendations should guide the clinical management of DE in high performance sport.

Yoga's impact on risk and protective factors for disordered eating: a pilot prevention trial

Yoga has been proposed as a strategy for improving risk and protective factors for eating disorders, but few prevention trials have been conducted. The purpose of this pilot study was to assess the feasibility and acceptability of a yoga series in female college students (n = 52). Participants were randomized to a yoga intervention (three 50-minute yoga classes/week for 10 weeks conducted by certified yoga teachers who received a 3-day intensive training) or a control group. Risk and protective factors, assessed at baseline, 5 and 10 weeks, included body dissatisfaction, negative affect, loneliness, self-compassion, positive affect, and mindfulness. Mixed models controlling for baseline levels of outcome variables were run. On average, participants attended 20 out of 30 yoga classes, and the majority of participants reported high levels of satisfaction with the yoga series. Appearance orientation decreased and positive affect increased in the yoga group relative to the control group. After controlling for baseline levels, the yoga group had a significantly higher positive affect than the control group. Changes in other outcomes were not statistically significant, as compared to the control condition. Future yoga research directions are discussed including education about body image, measure and sample selection, and use of an implementation science framework.

Yoga and eating disorder prevention and treatment: A comprehensive review and meta-analysis

Yoga is frequently used in conjunction with standard treatment approaches for eating disorders. However, yoga's efficacy and effectiveness in preventing and treating eating disorders has remained unclear. The aim of this comprehensive review and meta-analysis is to review the extant literature and assess the effects of yoga in the prevention and intervention of eating disorder symptoms and correlates in both clinical and non-clinical populations. Studies assessing yoga and its effect on eating disorder symptoms and/or body image as related to disordered eating, were eligible for inclusion. The comprehensive review details correlational, non-controlled, non-randomized controlled, and yoga comparison studies. For the meta-analysis, only randomized controlled trials comparing a yoga-based intervention to a non-yoga control group were included. In total, 43 studies are included in this review, with 11 trials involving 754 participants included in the meta-analysis. Results of the comprehensive review and meta-analyses results indicated yoga interventions demonstrated a small, significant effect on global eating disorder psychopathology, a moderate-to-large effect on binge eating and bulimia, and a small effect on body image concerns, as compared to the control conditions. There was no statistically significant effect on dietary restraint in either direction. Additionally, results indicated a small-to-moderate effect on a composite measure of eating disorder-related constructs. These findings suggest that yoga-based interventions may be an effective approach supporting the prevention and treatment of eating disorders.

Yoga Practice in a College Sample: Associated Changes in Eating Disorder, Body Image, and Related Factors Over Time

Yoga practice is associated with improvements in eating disorder (ED) symptoms and body dissatisfaction. This study continued to evaluate this relationship while also assessing changes in variables negatively associated with ED symptoms (self-compassion, mindfulness, body appreciation, self-efficacy) that are emphasized throughout yoga. Men were also included in this study given studies have predominantly focused on women. Participants (N = 99, 77.8% women) were recruited from a university-implemented yoga course and completed assessments at the beginning (Time 1 (T1)) and end (Time 2 (T2)) of an eight-week yoga course meeting three times a week for fifty minutes. Body dissatisfaction (ps <.05) and ED pathology (p = .02) were lower at T2. Body appreciation (p < .001), self-compassion (p = .01), yoga self-efficacy (p = .004) were higher at T2. Some gender differences emerged. Men reported greater reductions in concern with being overweight, (Overweight Preoccupation) from T1 (M = 2.46, SD = 0.61) to T2 (M = 2.13, SD = 0.61) compared to women, T1 (M = 2.75, SD = 0.98) to T2 (M = 2.69, SD = 0.97) associated with yoga practice. Men also reported greater improvements in body satisfaction (Appearance Evaluation) from T1 (M = 3.60, SD = 0.49) to T2 (M = 3.90, SD = 0.34) compared with women, T1 (M = 3.48, SD = 0.58) to T2 (M = 3.39, SD = 0.52) associated with yoga practice. Results suggest yoga may be associated with concurrent changes in protective and risk factors for ED in a college population.

Examining Body Appreciation and Disordered Eating in Adolescents of Different Sports Practice: Cross-Sectional Study

This cross-sectional study aimed to examine the associations between body appreciation, body functionality and disordered eating in a large adolescent sample of different levels and types of sports practice. Method: The sample consisted of 1412 adolescents (59.8% were girls). The ages ranged from 15 to 18 years old, with a mean age of 16.9 (SD = 0.5) for girls and 17.0 (SD = 0.4) for boys. Participants completed an anonymous questionnaire assessing the nature of sports participation, body appreciation, body functionality, self-esteem, body dissatisfaction, internalisation of sociocultural beauty ideals and disordered eating. A two-way ANOVA was employed to test the differences in body image concerns, body appreciation, perceived physical fitness and disordered eating behaviours in gender groups and groups of different sport types and levels. Multiple linear regression analyses were performed to predict disordered eating behaviours of different study variables. Results: Participants of leisure and competitive sports reported greater body appreciation, self-esteem and lower body dissatisfaction compared to non-participants. No differences in body appreciation and disordered eating were observed in adolescents involved in weight-sensitive and less weight-sensitive sports. Body appreciation and body functionality were associated with lower disordered eating in adolescent girls not participating in sports, leisure exercisers and participants of competitive sport as well as in boys participating in competitive sports, controlling for body mass index. Adolescent boys demonstrated greater body appreciation compared to girls. Conclusions: The results of this study support the knowledge of the protective role of positive body image preventing dysfunctional eating in adolescent girls of various sports practice and in competitive sports involved boys. Disordered eating prevention and clinical treatment programs for adolescents of different physical activity might benefit from including education about body appreciation and functionality.

Patterns of Health-Related Gender Inequalities-A Cluster Analysis of 45 Countries

PURPOSE

The paper explores gender inequalities between 45 countries across 10 health indicators among adolescents and whether those differences in health correlate with gender inequality in general.

METHODS

Data from 71,942 students aged 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children survey were analyzed. For this purpose, 10 indicators were selected, representing a broad spectrum of health outcomes. The gender differences in the countries were first presented using odds ratios. Countries with similar risk profiles were grouped together using cluster analyses. For each of the 10 indicators, the correlation with the Gender Inequality Index was examined.

RESULTS

The cluster analysis reveals systematic gender inequalities, as the countries can be divided into seven distinct groups with similar gender inequality patterns. For eight of the 10 health indicators, there is a negative correlation with the Gender Inequality Index: the greater the gender equality in a country, the higher the odds that girls feel fat, have low support from families, have low life satisfaction, have multiple health complaints, smoke, drink alcohol, feel school pressure, and are overweight compared with boys. Four indicators show a divergence: the higher the gender equality in a country in general, the larger the differences between boys and girls regarding life satisfaction, school pressure, multiple health complaints, and feeling fat.

CONCLUSIONS

Countries that are geographically and historically linked are similar in terms of the health risks for boys and girls. The results challenge the assumption that greater gender equality is always associated with greater health equality.

#Loveyourbody: The effect of body positive Instagram captions on women's body image

One increasing trend on social media is the posting of body positive content that aims to challenge narrow beauty ideals and instead promote acceptance and appreciation of all bodies. The aim of the present study was to experimentally investigate the effect of body positive captions attached to Instagram images on young women's body image. Participants were 384 women aged 18-30 years randomly assigned to view Instagram images of thin or average-sized women containing either body positive captions or no captions. In contrast to prediction, the body positive captions had no effect on body dissatisfaction or body appreciation. There was a significant effect of image type, whereby the average images resulted in less body dissatisfaction and greater body appreciation than the thin images. A significant three-way interaction indicated that for women high on thin-ideal internalisation, body positive captions on average images led to greater body appreciation, but lower body appreciation when attached to thin images. The results suggest that the visual imagery of an Instagram post is a more potent contributor to body image than any accompanying text. Presenting a more diverse array of women's bodies on social media is likely a more effective way to foster body satisfaction and appreciation.

A picture is worth a thousand words: The effect of viewing celebrity Instagram images with disclaimer and body positive captions on women's body image

Research has shown that exposure to Instagram images is harmful for women's body image. Although Instagram consists of photos of both peers and celebrities, the top followed Instagram accounts are held by thin and attractive female celebrities. The present study aimed to experimentally investigate whether two forms of Instagram caption could mitigate the detrimental effect of celebrity images on women's body image. Participants were 256 female undergraduate students who were assigned to view a set of celebrity images with either no caption, a disclaimer caption, or a body positive caption, or a control set of travel images. Results showed that exposure to celebrity images, in comparison to travel images, increased body dissatisfaction and decreased body appreciation. However, there was no significant effect of either form of caption. The effect of celebrity images was mediated by state appearance comparison and moderated by trait appearance comparison. It was concluded that the addition of disclaimer or body positive captions by attractive celebrities does not serve to improve women's body image.

Personality and body dissatisfaction: An updated systematic review with meta-analysis

This research synthesis explored whether major personality dimensions relate to body dissatisfaction. A comprehensive literature search identified 26 studies (37 independent samples) that met inclusion criteria (364 effect sizes; n = 39,109). Data were analyzed using inverse-variance weighted random effects meta-analysis. Mean effect sizes from 30 individual meta-analyses provided evidence that neuroticism (r = .30), extraversion (r = -.17) and conscientiousness (r = -.16), and to a lesser extent openness (r = -.10) and agreeableness (r = -.08), relate to body dissatisfaction. Effect sizes were smaller in models that controlled for body mass index, with non-significant effects for openness and agreeableness. There was some evidence of publication bias and substantial heterogeneity in computed averages. Random effects meta-regression showed that the association between neuroticism and body dissatisfaction decreased as the sample age increased. Measurement was the most important moderator across personality dimensions, with measures of appearance evaluation and body appreciation often showing smaller associations than other measures of body dissatisfaction. Effect sizes were not moderated by sample sex or world-region. Overall, findings show that higher levels of neuroticism, and lower levels of extraversion and conscientiousness, are associated with a greater risk of body dissatisfaction in men and women irrespective of actual body weight.

Psychometric properties of the Japanese version of the Body Appreciation Scale-2 for Children (BAS-2C)

Despite the heightened interest in positive body image research in recent years, few studies have explored positive body image among children. Examining the Body Appreciation Scale-2 for Children (BAS-2C) using a different cultural sample than the original version would thus be beneficial in extending the research on this topic. This research aimed to validate the BAS-2C for use in Japan. The measures were administered to 243 children, and the participants completed the survey in their classrooms with the support of a teacher. The survey was repeated after four weeks. Confirmatory factor analysis showed that the one-factor structure was the same as that of the original version, and the BAS-2C was invariant across gender. Scores on the BAS-2C demonstrated good internal consistency and test-retest reliability over a four-week period. In addition, construct validity was accrued through the BAS-2C's correlation with body dissatisfaction (among girls), self-esteem, and life satisfaction. Results indicated that the BAS-2C shows good psychometric properties among Japanese children, and supports further research into positive body image in this group.

Characterizing a body positive online forum: Resistance and pursuit of appearance-ideals

The body positive movement emerged in response to pressure to pursue the unattainable thin ideal, and promotes a more accepting stance towards the body. To date, however, little is known regarding the nature of online body positive content. Using publicly available data from a large online discussion platform (Reddit), all the forums to which commenters on a body acceptance forum (N = 1262) had also contributed were identified. For each pairing of 50 representative forums (i.e., a large number and proportion of body acceptance commenters), the commenter-overlap between the two forums was used to compute a network model, to detect communities of body acceptance commenters. By manually reviewing the topics of each community's forums, the shared interests of these commenters were identified. The majority of commenters (86 %) contributed to forums relating to women, feminism, relationships and support, and mental health. Large proportions of the commenters also revealed an interest in topics including body weight/shape, eating, exercise, and cosmetics. These findings confirm that original feminist tenets of body positivity remain present. However, our findings also suggest the existence of a sizeable subgroup interacting with topics related to the thin ideal, perhaps illustrating a gradual absorption of the body positive movement into mainstream culture.

Labels to prevent the detrimental effects of media on body image: A systematic review and meta-analysis

OBJECTIVE

Most advertisements contain thin-ideal imagery enhanced by digital modification. The deleterious effects on body image and eating disorder risk of exposure to such images have been well documented. One of the proposed macro-level solutions to mitigate these effects has been the use of labels on images, primarily disclaimer labels. A growing number of studies have explored the usefulness of such labels in protecting body image against the detrimental effects of media exposure; however, findings have been divergent.

METHODS

The current study aimed to conduct a systematic review and meta-analysis of the existing literature investigating the effects of including labels on media images on body image.

RESULTS

The systematic review identified n = 22 studies that were included in a narrative review, n = 18 were included in the meta-analysis. Overall, findings provided little support for the use of disclaimer or warning labels as a means of protecting against the detrimental effects of media exposure on body image. Furthermore, findings suggested that such labels might increase state appearance comparison when exposed to media images.

DISCUSSION

These findings are especially concerning in light of recent legislative efforts to mitigate media effects through the use of labels on imagery, as well as industry initiatives based on image labeling. Additional research examining alternative strategies for universal prevention of body image and eating concerns is warranted.

Research Review: Effectiveness of universal eating disorder prevention interventions in improving body image among children: a systematic review and meta-analysis

BACKGROUND

Increasingly, children are at risk of developing eating disorders. A systematic review and a meta-analysis were conducted to examine the effectiveness of universal eating disorder prevention interventions in improving body image, internalization of appearance ideals, and self-esteem among children aged 5-17 years old.

METHODS

Nine electronic databases were systematically searched from each database's point of inception to March 2019. The Cochrane Risk of Bias tool assessed each study's risk of bias, while the GRADE approach judged the overall evidence for each review outcome. A meta-analysis was conducted using the random-effect model to obtain standardized mean differences with 95% confidence intervals under the inverse variance method. Heterogeneity was assessed using I² statistic and Cochran's Q chi-squared test. Publication bias was assessed using funnel plots.

RESULTS

A total of 24 studies (22 trials) were included in this review. Universal interventions were found to be effective in improving children's body esteem, self-esteem, and internalization of appearance ideals at postintervention and at follow-up timepoints. Subgroup analyses found that girls benefited more from these interventions than boys. Multisessional interventions with an optimal duration of approximately one month were found to be more effective.

CONCLUSIONS

The findings encourage the incorporation of universal preventive interventions into school curricula to benefit most children. Laypeople such as teachers can deliver these interventions, but content experts should address topics on body dissatisfaction. Due to the low quality of evidence, as accorded by the GRADE approach, current findings should be validated by future research.

Mejora de la satisfacción corporal en la madurez a través de un programa específico de imagen corporal

Se compara la mejora lograda en satisfacción corporal por un programa específico de intervención en imagen corporal en personas mayores con los resultados obtenidos en programas de intervención y animación social, con el propósito de valorar si son significativamente mejores que otros programas de carácter social.  De ser así, resulta relevante intervenir específicamente sobre la satisfacción corporal durante la vejez para evitar otros problemas relacionados como la depresión o la baja autoestima. En el estudio, se analizan las conexiones encontradas entre el género, la edad y la presencia de pareja sentimental estable, como características de gran importancia para la satisfacción corporal. Los resultados muestran que, aunque la relevancia de la satisfacción corporal durante esa etapa es cualitativamente diferente a edades anteriores, la intervención específica en imagen corporal es significativamente más efectiva que otros programas preventivos o que la maduración experimental.

Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis

Eating disorders are severe mental health conditions, with substantial consequences for health and quality of life. Such disorders are strongly associated with body image concerns. It is important to consider treatments that might enhance our ability to treat such cases. Recently, there has been a growing body of research on self-compassion in relation to such problems. However, we are not yet clear about the extent of such effects, given the range of studies and methodologies used. Therefore, a systematic literature review was carried out using four key databases. Meta-analysis was used to reach conclusions about the size of the effects and moderators. Random-effects meta-analyses were conducted with 59 studies. Higher self-compassion was associated with lower eating pathology, reduced body image concerns, and greater positive body image, with medium to strong effect sizes (respectively, r = -0.34, r = -0.45, r = 0.52). Furthermore, self-compassion interventions for eating pathology and body image were effective, and superior to control groups (respectively, g = 0.58, g = 0.39). These findings support the role of self-compassion in understanding and addressing eating and body image concerns. Self-compassion appears to be an adaptive emotion regulation strategy in eating disorders and body image.

Self-to-others and self-to-self relationships: paths to understanding the valence of body image and eating attitudes in emerging adult women

PURPOSE

Interpersonal and intrapersonal factors contributing to body appreciation in emerging adult women remain poorly explored. Thus, the present study aimed to test the impact of early memories of warmth and safeness with peers, self-compassion, and social safeness, in body appreciation and in disordered eating attitudes and behaviours.

METHODS

A total of 387 women aged between 18 and 25 completed a set of self-report questionnaires. Data were analysed through descriptive and correlation statistics, and the suitability of a theoretical model was explored via path analysis. Self-report instruments assessed participants' weight and height, early memories of warmth and safeness with peers, self-compassion, social safeness, body appreciation, as well as disordered eating.

RESULTS

Early memories of warmth and safeness with peers associated with higher self-compassion and feelings of social safeness, which were both positively linked to body appreciation. Body appreciation associated with a lower display of disordered eating.

CONCLUSION

It seems that childhood and adolescent experiences may have an important influence on the development of self-to-self and self-to-others secure relationships, with consequences on the way women behave and relate with their unique body characteristics. The pertinence of developing self-compassion and affiliative skills to promote positive body image among females is suggested, as well as of applying compassion-based strategies when clinically approaching symptoms of eating disorders.

LEVEL OF EVIDENCE

Cross-sectional descriptive study, Level V.