Improving the body image, eating attitudes, and behaviors of young male and female adolescents: a new educational approach that focuses on self-esteem

A Pilot Evaluation of the Respect You Curriculum

BACKGROUND

The objective of this study is to evaluate the Respect YOU program's impact on students' eating expectancies, body image satisfaction levels, self-efficacy, and knowledge. A total of 444 (intervention cohort n = 348, control cohort n = 96) underclassmen enrolled in health or physical education courses from 7 high schools in the Midwest participated in the study.

METHODS

A repeated measure research design was utilized to assess students' eating expectancies, body image satisfaction levels, self-efficacy, and knowledge. More specifically, paired t-tests were conducted to compare outcome measurements to evaluate the efficacy of the intervention.

RESULTS

Among the students who received the intervention (n = 348), there was a statistically significant change in scores for eating expectancies (Z = -14.403, p < .001), body image satisfaction levels (Z = -14.114, p < .001), social media self-efficacy (Z = 14.868, p < .001), and knowledge scales (Z = -16.100, p < .001) at post-intervention and compared to the control group.

CONCLUSIONS

Results indicate that the Respect YOU program was effective in improving body image scores, eating expectancies, self-esteem, and knowledge-related outcomes among students post-intervention. These results can be used to further develop educational programming to address body image concerns and disordered eating among adolescents.

Body Perceptions and Psychological Well-Being: A Review of the Impact of Social Media and Physical Measurements on Self-Esteem and Mental Health with a Focus on Body Image Satisfaction and Its Relationship with Cultural and Gender Factors

This narrative review examines the interplay among body image perceptions, social media influence, physical measurements, and their impact on psychological well-being, focusing on the roles of cultural and gender differences and the need to understand the research methodologies employed in this field. In the age of digital proliferation, platforms like Instagram and Facebook have reshaped body image concerns, often leading to increased dissatisfaction and psychological distress due to constant exposure to idealized images and a culture of social comparison. Physical attributes such as weight, height, and BMI are scrutinized under societal standards of health and attractiveness, contributing to a spectrum of mental health issues including low self-esteem, depression, and eating disorders. This examination reveals how cultural norms and gender expectations further complicate body image perceptions, affecting individuals differently based on societal and personal ideals. It synthesizes current research and types of methods to illuminate how these factors together influence mental health and self-esteem, advocating for comprehensive interventions and policy measures aimed at mitigating body dissatisfaction and promoting a healthier, more inclusive understanding of body image. By delving into the complexities of body image satisfaction and its psychological implications, this review highlights the necessity of addressing these concerns within public health and social policy frameworks, underscoring the importance of a multifaceted approach to enhance individual and societal well-being.

Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training

BACKGROUND

Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD).

AIMS

For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms.

METHOD

The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training.

RESULTS

In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high.

CONCLUSIONS

Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.

Cross-sectional and longitudinal associations between self-esteem and BMI depends on baseline BMI category in a population-based study

BACKGROUND

Some studies have reported associations between self-esteem and weight status, but longitudinal data on adults remain scarce. The aim of this population-based study was to analyze the cross-sectional and longitudinal association between self-esteem and body mass index (BMI) and to investigate whether baseline BMI has an impact on this association.

METHODS

In 2016, 29,735 participants aged ≥ 18 years in the NutriNet-Santé cohort completed the Rosenberg Self-Esteem Scale. BMI was self-reported yearly over a 4-year period. Association between self-esteem and BMI was assessed using mixed models and logistic regressions. Analyses were stratified by BMI (categorical) at baseline and adjusted on sociodemographic and lifestyle characteristics.

RESULTS

At baseline, higher self-esteem was associated with higher BMI in normal weight individuals(p = 0.32), and with lower BMI in obese class II and III individuals (p = 0.13). In addition, higher baseline self-esteem was associated with BMI increase over time in normal weight individuals (p = 0.15). Among normal weight individuals, those with higher self-esteem were less likely to show a decrease in their BMI (p = 0.005), while no association was observed with BMI increase (p = 0.81).

DISCUSSION

Our findings suggest that the association between self-esteem and BMI depends on the initial category of BMI, with a negligible effect of self-esteem.

Understanding suicidality in Pacific adolescents in New Zealand using network analysis

INTRODUCTION

Pacific adolescents in New Zealand (NZ) are three to four times more likely than NZ European adolescents to report suicide attempts and have higher rates of suicidal plans. Suicidal thoughts, plans, and attempts, termed suicidality in this study, result from a complex dynamic interplay of factors, which emerging methodologies like network analysis aim to capture.

METHODS

This study used cross-sectional network analysis to model the relationships between suicidality, self-harm, and individual depression symptoms, whilst conditioning on a multi-dimensional set of variables relevant to suicidality. A series of network models were fitted to data from a community sample of New Zealand-born Pacific adolescents (n = 550; 51% male; Mean age (SD) = 17 (0.35)).

RESULTS

Self-harm and the depression symptom measuring pessimism had the strongest associations with suicidality, followed by symptoms related to having a negative self-image about looks and sadness. Nonsymptom risk factors for self-harm and suicidality differed markedly.

CONCLUSIONS

Depression symptoms varied widely in terms of their contribution to suicidality, highlighting the valuable information gained from analysing depression at the symptom-item level. Reducing the sources of pessimism and building self-esteem presented as potential targets for alleviating suicidality amongst Pacific adolescents in New Zealand. Suicide prevention strategies need to include risk factors for self-harm.

Normative body image development: A longitudinal meta-analysis of mean-level change

This meta-analysis synthesized longitudinal data on mean-level change in body image, focusing on the constructs of body satisfaction and dissatisfaction, body esteem, perceived attractiveness, valuation, self-objectification, and body shame. We searched five databases and accessed unpublished data to identify studies that assessed body image at two or more time points over six months or longer. Analyses were based on data from 142 samples representing a total of 128,254 participants. The age associated with the midpoint of measurement intervals ranged from 6 to 54 years. Multilevel metaregression models examined standardized yearly mean change, and the potential moderators of body image construct, gender, birth cohort, attrition rate, age, and time lag. Boys and men showed fluctuations in overall body image with net-improvements between ages 10 and 24. Girls and women showed worsening body image between ages 10 and 16, but improvements between ages 16 and 24. Change was greatest between ages 10 and 14, and stabilized around age 24. We found no effect of construct, birth cohort, or attrition rate. Results suggest a need to revise understandings of normative body image development: sensitive periods may occur somewhat earlier than previously believed, and body image may show mean-level improvements during certain age ranges.

Body image and depression in endometriosis: Examining self-esteem and rumination as mediators

Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.

Adaptive body image can be contagious: An examination of college women facing situational body image threats

The present research examined whether and which adaptive body image displays in peers can promote more adaptive body image in self. In two studies, female-identified undergraduates recalled a personally distressing body image event. In Study 1, participants (N = 158) then heard an alleged female-identified peer responding to her own distressing body image event with either self-compassion, self-esteem enhancement, or distraction. Participants across conditions reported increased body acceptance and body image-related self-compassion, and decreased body image distress, but changes did not vary by condition. Study 2 sought to determine which component(s) common to Study 1's conditions explained the benefits participants experienced. Participants (N = 207) listened to an alleged peer: describe body image distress with which she coped adaptively; express body image distress but no adaptive coping; or deny body image distress and relate positively to her body. Hearing a peer cope adaptively with body image distress yielded the greatest body image benefits, whereas hearing a peer deny body image distress was generally least helpful. Results suggest that learning how a peer copes adaptively with body image distress may be most helpful in the face of personal body image distress, and support the overarching theory that adaptive body image may be socially transmissible.

From Self-Doubt to Pride: Understanding the Empowering Effects of Delivering School-Based Wellness Programmes for Emerging Adult Facilitators-A Qualitative Study

Ample literature exists on the impact of prevention programmes on their target audience, while much less is known about how delivering such programmes influences their facilitators. Even less literature exists on the emotional and social processes that form this potential impact on facilitators. The current study analysed qualitative in-depth, non-structured interviews, as well as written essays provided by 33 student-facilitators who delivered the "Favoring Myself" programme in Israel during 2019-2021. This school-based wellness programme comprised 10 weekly, 90 min sessions on self-care behaviours, media literacy, self-esteem, and positive body image, which are well-known protective factors against risky behaviours. A thematic analysis was applied to explore the main themes in the collected data. An interesting affective transformation from self-doubt to pride in themselves emerged as a shared experience of these young facilitators. Facilitators related their ability to facilitate the programme, as well as to undergo an individual maturation and empowerment experience, to certain components of the programme itself, such as the preparatory course, individual supervision, and the peer-group experience. This shift from doubt to pride is discussed using two frameworks-a theoretical discourse of emerging adulthood as a developmental stage, and the self-determination theory.

Development and psychometric evaluation of an empirically-derived daily checklist of weight control: Consumption-reduction strategies and health-focused strategies in college students

Objective: Many college women report engaging in weight control strategies, yet little is known about which strategies are used and how often. The current study's goal was to evaluate the factor structure of a comprehensive list of weight control behaviors used in the previous 24-hours. Participants: Undergraduate women (N = 286) were recruited from a southwestern university. Methods: Participants reported their weight control strategies for the previous 24 hours on a checklist compiled from previous studies. Results: Exploratory and confirmatory factor analyses indicated that a 14-item, 2-factor ("Consumption-reduction", "Health-focused" Strategies) structure was a good fit of the data. Tests of longitudinal measurement invariance found support for using the checklist to make meaningful comparisons across time. Conclusions: This study developed a checklist of past 24-hour weight-control strategy usage, thereby providing a step toward developing an instrument that may be used for weight control or early intervention for disordered eating.

Universal programs to prevent eating disorders in children and adolescents: A scoping review of ethical, legal, organizational and social impacts

BACKGROUND

Appropriate and timely consideration of ethical, legal, organizational, and social issues in universal preventive programs for eating disorders (UPPED) are relevant for the approval, funding and implementation of health-policy decision making.

OBJECTIVE

To identify and analyse the ethical, legal, organizational, and social aspects involved in interventions aimed at the universal prevention of eating disorders (ED) in children, pre-adolescents and adolescents in the school settings.

METHOD

A scoping review of the literature was carried out. MEDLINE, EMBASE, CENTRAL, PsycINFO, and Social Science Citation Index were searched for studies published in English or Spanish. The quality of the studies was assessed using specific scales for each study design.

RESULTS

Fourteen studies were included: one scoping review; four narrative reviews, six observational studies, two qualitative studies, and one mixed methods study. Results were narratively synthesised according to: (1) equity; (2) gender perspective; (3) potential harm; (4) participants and facilitators profile; (5) feasibility; and (6) acceptability.

CONCLUSIONS

Interactive programs with relevant contents for participants have greater acceptability. Programs focussed on developing competencies can reduce the risk of potential harm. Incorporating a gender perspective contributes to improving equity. Teachers with prior training in ED are well suited as facilitators of these programs.

Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg’s self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables ‘number of meals’ (p < 0.01), ‘dieting’ (p < 0.01), and ‘drug consumption to lose weight’ (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.

The Influence of Perfectionism, Self-Esteem and Resilience on Young People's Mental Health

The current study explored whether maladaptive perfectionism and low self-esteem constituted reliable risk factors of student mental illness, as well as determining whether resilience moderates these predictive relationships. 434 University undergraduate students were recruited. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7). Perfectionism, self-esteem and resilience were analyzed in relation to the PHQ9 and GAD-7 scores via a regression analysis. Perfectionism discrepancy, self-esteem and resilience all significantly predicted depression and anxiety. Hierarchical regression analysis revealed a statistically significant amount of additional variance to be explained by resilience for depression and anxiety, than for perfectionism and self-esteem alone. Maladaptive perfectionism and low self-esteem predispose an individual to depression and anxiety, though resilience may act as a protective factor against development of mental illness.

Disordered eating through the lens of positive psychology: The role of embodiment, self-esteem and identity coherence

Applying a positive psychology perspective, this study aimed to identify potential intra-individual factors that might protect against the development of disordered eating in a community sample of young women and men (N = 510; 56 % women; M_age = 24.3). Based on existing literature, the study included the general resilience factors of self-esteem and identity coherence as well as two dimensions of positive embodiment (positive body connection and comfort, and agency and functionality). All factors were negatively correlated with disordered eating among women and men. Hierarchical regression analyses indicated that positive embodiment, specifically positive body connection, was a significant predictor of lower degrees of disordered eating symptoms in both women and men, followed by self-esteem. The overall prediction model accounted for 42.6 % in the variation of disordered eating symptoms for women and 23.9 % for men. Prevention and treatment interventions promoting health factors that protect against the development of eating disorders are much needed. The present study informs such efforts by emphasizing the promotion of positive embodiment.

Associations between weight status, body satisfaction, ethnic identity and self-esteem in Oceanian adolescents

BACKGROUND

Self-esteem has consistently been observed to be relatively low in adolescents with obesity. In the Pacific region, the prevalence of obesity in adolescence is high, but few studies have considered issues of self-esteem in this population.

OBJECTIVE

To examine associations between weight status, body dissatisfaction and self-esteem in a sample of New Caledonian adolescents and to test for moderation effects of ethnicity on predictors of self-esteem.

METHODS

Objective anthropometric measures (height, weight, waist circumference and thickness of skinfolds) were obtained in a multi-ethnic sample of New Caledonian adolescents. Body mass index (BMI), waist-to-height ratio and the sum of four skinfolds thickness were used as proxies of weight status. Indices of ethnic identity, self-esteem, socio-demographic data (socioeconomic status, ethnicity, gender, urbanicity of residence) and body dissatisfaction were obtained using survey methods.

RESULTS

Between-group analyses indicated that adolescents of European/white origin had significantly higher self-esteem than adolescents with Oceanian Non-European Non-Asian ancestry (ONENA). However, low self-esteem was significantly associated with weight status and body dissatisfactions in European/white adolescents but not ONENA adolescents. Ethnicity moderated the relationships of predictors (BMI z-score, body dissatisfaction, age, urbanicity and ethnic identity) on self-esteem, and the strongest predictors of self-esteem were ethnicity and ethnic identity.

CONCLUSIONS

While self-esteem has important consequences for adolescent well-being and health outcomes, these results highlight the importance of applying different steps to develop and maintain healthy self-esteem in the Pacific region.

[The Effects of Programs on Body-Image Improvement in Adolescents: A Systematic Review and Meta-Analysis]

PURPOSE

This study's objective was to investigate the effects of programs that improve adolescents' body image, using a systematic review and meta-analysis.

METHODS

A literature search was performed in eleven electronic databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Population characteristics, contents of the programs, and measured outcomes were systematically reviewed from 21 selected studies. To estimate the size of the effects, meta-analysis was conducted using Comprehensive Meta-Analysis software.

RESULTS

The contents of the programs that aimed to improve body image included physical, psychological, interpersonal, and sociocultural interventions. Sixteen studies were meta-analyzed to estimate the effect size of body-image improvement programs. Results showed that the program for body-image improvement had significant effects on body satisfaction (effect size [ES] = 0.56, 95% confidence interval [CI] = 0.23 to 0.89), and body dissatisfaction (ES = - 0.15, 95% CI = - 0.23 to - 0.08).

CONCLUSION

The program for body image improvement in adolescents includes a combination of physical, psychological, interpersonal relationship, and socio-cultural dimensions. The program that seeks to improve body image appears to be effective at increasing body satisfaction, and at reducing body dissatisfaction in adolescents. Thus, it is necessary to develop and apply multidimensional programs for adolescents to have a positive body image.

Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study

BACKGROUND

Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States.

OBJECTIVE

The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors.

METHODS

Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012.

RESULTS

The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F_15,4966=105.8; P<.001).

CONCLUSIONS

This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex.

You and I Both: Self-Compassion Reduces Self-Other Differences in Evaluation of Showing Vulnerability

People tend to be overly critical of their own displays of vulnerability, whereas observers evaluate others’ showing of vulnerability rather positively (beautiful mess effect). We propose that self-compassion might buffer against such misperceptions of one’s own vulnerabilities. When confronted with challenging situations, self-compassionate people are kind to themselves, see adversity as inevitable, and face the difficulty of their circumstances without overexaggeration. Thus, we hypothesized reduced self–other differences in the evaluation of showing vulnerability in self-compassionate individuals. The hypothesis was addressed in four studies. The first two studies measured self-compassion either immediately (Study 1a) or substantially (Study 1b) before participants evaluated showing of vulnerability. Studies 2 and 3 tested the generalizability of the hypothesis across different situations as well as the discriminant validity of self-compassion’s role in the reduction of the beautiful mess effect. Implications for research and practice are discussed.

Self-Esteem and Binge Eating among Adolescent Boys and Girls: The Role of Body Disinvestment

Although low self-esteem and body disinvestment have been recognized as potential risk factors for disordered eating, no studies have explored how these factors may work together to predict binge eating in adolescents. Therefore, we hypothesized a path model for girls and boys separately to investigate whether the body’s investment dimensions (feelings towards the body, physical touch, body care, body protection) mediate the relationship between self-esteem and binge eating, and age moderate such relationships. Participants were 1046 Italian students aged between 11 and 19 years (472 girls, M_age = 14.17; 574 boys, M_age = 14.60) screened through self-report measures. Both models showed an acceptable fit (males: χ²₍₂₂₎ = 30.441; RMSEA = 0.026; CFI = 0.99; TLI = 0.97; SRMR = 0.023; females: χ²₍₂₂₎ = 34.723; RMSEA = 0.35; CFI = 0.98; TLI = 0.95; SRMR = 0.029). Negative body feelings and reduced body protection fully mediated the relationship between self-esteem and binge eating, regardless of gender. Our findings highlight the importance of interventions promoting body emotional investment to reduce adolescents’ vulnerability to binge eating.

The Effects of Self-Compassion and Self-Esteem Writing Interventions on Women’s Valuation of Weight Management Goals, Body Appreciation, and Eating Behaviors

In this study, we examined the effects of body-focused daily self-compassion and self-esteem expressive writing activities on women’s valuation of weight management goals, body appreciation, bulimic symptoms, and healthy and unhealthy eating behaviors. One-hundred twenty-six women, recruited from the community and a university participant pool ( Mage = 29.3, SD = 13.6), were randomly allocated to one of the three writing conditions: body-focused self-compassion, body-focused self-esteem, or control. Women reflected on a moment within the past 24 hours that made them feel self-conscious about their bodies, eating, or exercise habits (self-compassion and self-esteem conditions) or on a particular situation or feeling that occurred in the past 24 hours (control condition) for 4–7 days. At post-treatment (24 hours after the intervention), women in the self-compassion group demonstrated decreased bulimic symptoms, while women in the self-esteem and control conditions did not. Furthermore, clinically significant changes in bulimic symptoms were associated with being in the self-compassion condition but not in the self-esteem or control conditions. Results suggest that body-focused writing interventions may be more effective in temporarily reducing eating disorder symptoms in women if they focus on harnessing self-compassion. Additional online materials for this article are available on PWQ ’s website at http://journals.sagepub.com/doi/suppl/10.1177/03616843211013465

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

The Relationship between Emotional Intelligence, Obesity and Eating Disorder in Children and Adolescents: A Systematic Mapping Review

Eating and weight disorders often develop early in life and cause a long-standing significant health burden. Given the documented role of emotional intelligence (EI) in shaping the body image and predicting the onset of eating disorders, knowledge of the mechanisms involved in EI among youth is fundamental to designing specific interventions for screening and prevention of obesity and eating disorders (EDs). The present systematic mapping review was aimed to explore and quantify the nature and distribution of existing research investigating the impact of EI on EDs in young people. A systematic search for relevant articles was conducted using PubMed, Scopus, PsycINFO and Web of Science databases. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to assess the included studies’ methodological quality. The included studies’ results were mapped based on stratification by age groups (children, preadolescents, and adolescents), population (clinical vs. non-clinical) and disordered eating outcomes. Nine studies were included, supporting the association between EI and body image dissatisfaction, ED risk and bulimic symptomatology, but not with anorexic symptoms. Research on children and clinical populations was scant. Further studies are needed to deepen the role of EI in the genesis and maintenance of EDs.

The Norwegian healthy body image intervention promotes positive embodiment through improved self-esteem

We examined both direct and indirect effects of the Healthy Body Image (HBI) intervention on positive embodiment among Norwegian high school students. In total, 2446 12th grade boys (43 %) and girls (mean age 16.8 years) from 30 schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. We tested mediation models using path analysis and found that among several hypothesized mediators, only self-esteem mediated a positive intervention effect on positive embodiment for both boys and girls. A direct effect of the intervention on positive embodiment was only found in girls. The study provides novel findings indicating that health promotion interventions to address a positive embodiment should focus on enhancing adolescent's self-esteem. Serial mediation modeling might reveal more complex explanations of change mechanisms and could further evolve current knowledge.

Predictors of health behaviours among Indian college students: an exploratory study

Purpose

The purpose of this study is to understand the association between health behaviours of diet, physical activity, smoking cigarettes, alcohol consumption, safe sex and sleep quality with demographic (e.g. age, gender) and psychological (i.e. stress, self-esteem and sense of coherence) factors in Indian residential college students.

Design/methodology/approach

Students studying for Bachelor of Technology at residential colleges in India were invited to complete an online questionnaire regarding their health behaviours, demographics and psychological variables. Each health behaviour was regressed onto demographic and psychological factors to determine which of them were associated with performing each behaviour.

Findings

There was no clear pattern of predictors for the health behaviours overall. Self-esteem was related to healthy diet, being single was related to adequate sleep, higher parental income was related to safer sex and being older was related to more alcohol use and safer sex.

Research limitations/implications

This study revealed that health education efforts may need to be designed for specific behaviours and correlates among Indian college students. Interventions regarding (1) healthy eating should target students with lower self-esteem, (2) sleep should target students in a relationship and (3) safer sex should target younger students and those from less affluent backgrounds.

Originality/value

This research is one of the first attempts to study the predictors of health behaviours among Indian college students. The study highlighted that psychological factors (e.g. self-esteem) and demographic factors (e.g. relationship status, parental income, age) affect different health behaviours. These findings can help health educators to design tailored interventions and aid in health education and promotion among Indian college students.

Evaluation of Teen BodyWise: A pilot study of a body image group adapted for adolescent inpatients with anorexia nervosa

PURPOSE

Body image disturbance is a key characteristic of anorexia nervosa (AN); however, research into these difficulties among adolescents with AN is limited and is yet to assess the best treatments for this population.

METHODS

Fifty-two adolescents receiving inpatient treatment for AN attended Teen BodyWise, an eight-session body image group adapted for adolescents. Measures assessing shape and weight concerns, ability to discuss body image, sociocultural attitudes, body avoidance, body checking, and motivation were given before and after the group, and participant feedback was elicited.

RESULTS

Significant improvements were found for shape and weight concerns, ability to discuss body image, body checking and sociocultural attitudes. Participants were generally satisfied with the group and found it helpful, yet some aspects were experienced as challenging.

CONCLUSIONS

Teen BodyWise has potential benefits for adolescents with AN. Controlled research is needed to determine the effectiveness of Teen BodyWise.

LEVEL OF EVIDENCE

Evidence obtained from multiple time series with or without the intervention, such as case studies, Level IV.

Diabetes-specific self-esteem, self-care and glycaemic control among adolescents with Type 1 diabetes

AIMS

To explore the relationships between diabetes-specific self-esteem, self-care and glycaemic control among diverse adolescents with Type 1 diabetes.

METHODS

Adolescents (aged 13-21 years) diagnosed with Type 1 diabetes for at least one year, receiving care at an urban medical centre, completed a self-report battery including demographic information, the Diabetes-Specific Self-Esteem Scale and Self-Care Inventory. Glycaemic control (HbA_1c ) was obtained from medical records at recruitment and one year later. Bivariate correlation and multiple linear regression assessed relationships between the Diabetes-Specific Self-Esteem scale, Self-Care Inventory and HbA_1c at baseline and one year.

RESULTS

Participants included 85 adolescents (15.9 ± 2.1 years; 53% women; 47% Hispanic/Latino). Diabetes-specific self-esteem scores did not differ based on patient characteristics but were significantly correlated with baseline self-care (r = 0.59, P < 0.001) and HbA_1c at baseline (r = -0.51, P < 0.001) and one year later (r = -0.48, P < 0.001). Diabetes-specific self-esteem remained a significant correlate of baseline (β = -0.41, P < 0.001) and follow-up HbA_1c (β = -0.37, P = 0.008) when adjusting for covariates and self-care. Diabetes-specific self-esteem was not significantly associated with change in HbA_1c .

CONCLUSIONS

Results suggest that diabetes-specific self-esteem is significantly associated with self-care and glycaemic control among diverse adolescents with Type 1 diabetes. Diabetes-specific self-esteem may be more closely related to HbA_1c than reports of the frequency of self-care behaviours, and could represent a useful tool for clinical and research applications.

The effect of teaching puberty health concepts on the basis of a health belief model for improving perceived body image of female adolescents: a quasi-experimental study

Background

As children approach adolescence, they focus increasingly on their appearance and physical attraction due to teenage body-image. Teaching the concepts of adolescent health changes an individual’s attitudes towards parts of the body. The health belief model (HBM) is one of the significant pedagogic models in health education. According to this model, the individual’s decision and motivation for adopting healthy behaviors depends on three separate categories “personal perception, adaptive behaviors, and probability of performing that action or behavior”. This study investigated the effect of teaching puberty health concepts on the basis of a HBM on perceived body image in female adolescents.

Methods

A quasi-experimental research design was used in the study. This study was conducted with 60 sixth grade girls in state elementary schools in Yazd, Iran, that were selected with cluster sampling method and assigned randomly into experimental and control groups. The experimental group were educated in the school during eight 45-min sessions based on the HBM, whereas the control group were educated using the traditional lecturing method. The data were collected with demographic and self-body image questionnaires completed before and after intervention. The data were analyzed with SPSS16 using analysis of covariance (ANCOVA).

Results

The mean age of the participants was 12.16 ± 0.74 years. The findings showed that “perceived body image” and “students’ self-attitude” improved significantly after intervention; yet, no significant difference was found between the subscales “attitudes towards weight” and “satisfaction with various parts of the body”.

Conclusion

The results of the study confirmed the efficacy and efficiency of teaching puberty health on the basis of the HBM on improving perceived body image in female adolescents.

Imagen corporal en adolescentes lituanos de 11 a 19 años. Diferencias según actividad física e IMC

Se estudió la imagen corporal y las diferencias en la misma según actividad física e IMC, en 2942 adolescentes lituanos (1405 chicos y 1537 chicas), de 11 a 19 años. La imagen corporal se midió mediante el cuestionario HBSC, la actividad física mediante el cuestionario PACE y el IMC con la fórmula peso/altura2, clasificando a la población en Sobrepeso/Obesidad según el IOTF. Las chicas se veían más gordas que los chicos (t2935.50= 11.37; p=0.000; d=0.420). Los sujetos que realizaban menos actividad física (t2012.21= 2.57; p=0.010; d=0.115) y aquellos con sobrepeso/obesidad (t392.04= 14.86; p=0.000; d=1.501) tuvieron peor imagen corporal. Se recomienda implementar programas de actividad física y programas psicológicos para mejorar la imagen corporal y la composición corporal de los adolescentes lituanos, prestando especial atención a las chicas, a aquellos que realizan menos actividad física y a aquellos con sobrepeso/obesidad.

Effectiveness of a multi-session positive self, appearance, and functionality program on women's body satisfaction and response to media

Women's relationship with their bodies may be improved through activities which encourage them to focus on the positive elements of their appearance, the functional qualities of their body, and positive aspects of themselves in general. This study examined the effectiveness a multi-session program addressing these elements. Across two online sessions, 117 Australian women (M_age = 23.48) completed writing tasks about the positive elements of their appearance, body functionality, and who they are as a person, as well as engaging with functionality-focused public health campaigns. A control group completed matched tasks on stress management. Results showed that both groups had improvements across trait body appreciation, self-objectification, and weight concern across the program. Within-session state improvements were found across stress, body appreciation, appearance and functionality satisfaction for both groups. An online media exposure task was used one week post-program completion (n = 81). Idealised media exposure reduced functionality satisfaction in both groups but did not impact any other outcome measure. Findings suggest that tasks encouraging positive reflections on appearance, functionality, and self are useful in improving women's body satisfaction. Issues around choice of control group are discussed.

Self-Esteem as a Potential Mediator of the Association Between Social Integration, Mental Well-Being, and Physical Well-Being

Previous research points to a significant impact of social integration and self-esteem on well-being. The present study examined whether self-esteem constitutes one pathway from social integration in the classroom to mental and physical well-being of students and accordingly serves as a mediator. Therefore, 163 students (mean age: 12.98 years, age range: 9-17 years, 57.9% male) of three German secondary schools were examined regarding their experience of social integration, self-esteem, and mental as well as physical well-being. Results revealed that self-esteem mediated the effect of social integration on mental and physical well-being. This finding elucidates one pathway from social integration to well-being and points to the importance of improving both self-esteem and social integration for the promotion of well-being among adolescents.

Protective Effect of Biculturalism for Health Amongst Minority Youth: The Case of Pacific Islander Migrant Youths in Hawai'i

This study investigates the mechanisms by which biculturalism impacts various health outcomes amongst youth migrants to Hawai'i who are from the US-Affiliated Pacific Islands jurisdictions. Using purposive sampling, 284 males and females (twelve to nineteen years old) of Pacific Islander ethnicities in Hawai'i completed a survey. Results from path analysis showed that biculturalism significantly and positively affected self-esteem that, in turn, improved eating attitude, body satisfaction and perceived well-being. Further, eating attitude increased healthy eating behaviour and body satisfaction that, in turn, positively affected general health perception and body satisfaction. Positive smoking attitudes increased smoking activities, which negatively affect general health perception. The study demonstrated that self-esteem impacted overall health through its influence on enhancing positive perceptions about the importance of healthy eating, body satisfaction and well-being. Biculturalism indirectly led to increased self-esteem, which in turn directly influenced attitudes about healthy eating, body satisfaction and perceived well-being. Our study provides strong evidence that addressing the problem of health disparities for minority populations in the USA has to start with reaffirming the value of diversity and multiculturalism and embracing an individual's historic cultural identity. Specific implications for funding agencies and researchers of minority health programs are discussed.

Developing young men's wellbeing through community and school-based programs: A systematic review

Boys and young men have unique health-related needs that may be poorly met by existing programs and initiatives. The mismatch between the needs of boys and young men and current service offerings-driven largely by social determinants of health such as masculinity-may stymie health status. This is evidenced through high rates of self-stigma, accidental death or suicide, and low rates of help seeking and health literacy among populations of boys and young men. With growing interest in improving wellbeing and educational outcomes for all young people (including boys and young men), this systematic review aimed to evaluate community and school-based programs with specific focus on program features and outcomes directly relevant to young males aged 12-25 years. Five data-bases were searched; Medline, EMBASE, PsycInfo, ERIC, and ERAD. Articles were included if they evaluated an intervention or program with a general or at-risk sample of young men, and measured a psychological, psychosocial, masculinity, or educational outcome. The majority of the 40 included studies had high quality reporting (62.5%). Synthesised data included theoretical frameworks, intervention characteristics, outcomes, and key results. Of the included studies, 14 were male-focussed programs, with masculinity approaches directed towards program aims and content information. The emergent trend indicated that male-targeted interventions may be more beneficial for young men than gender-neutral programs, however, none of these studies incorporated masculine-specific theory as an overarching framework. Furthermore, only three studies measured masculine-specific variables. Studies were limited by a lack of replication and program refinement approaches. It is concluded that there is significant scope for further development of community and school-based health promotion programs that target young men through incorporation of frameworks that consider the impact of gendered social and environmental determinants of health. Evaluation of these programs will provide researchers and practitioners with the capacity for translating beneficial outcomes into best-practice policy.

A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3-month follow-up

Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (η²  = 0.04) and in disordered eating attitudes/behaviours (η²  = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs.

Annual Research Review: Developmental computational psychiatry

Most psychiatric disorders emerge during childhood and adolescence. This is also a period that coincides with the brain undergoing substantial growth and reorganisation. However, it remains unclear how a heightened vulnerability to psychiatric disorder relates to this brain maturation. Here, we propose 'developmental computational psychiatry' as a framework for linking brain maturation to cognitive development. We argue that through modelling some of the brain's fundamental cognitive computations, and relating them to brain development, we can bridge the gap between brain and cognitive development. This in turn can lead to a richer understanding of the ontogeny of psychiatric disorders. We illustrate this perspective with examples from reinforcement learning and dopamine function. Specifically, we show how computational modelling deepens an understanding of how cognitive processes, such as reward learning, effort learning, and social learning might go awry in psychiatric disorders. Finally, we sketch the promises and limitations of a developmental computational psychiatry.

When Is Teenage Plastic Surgery versus Cosmetic Surgery Okay? Reality versus Hype: A Systematic Review

Plastic surgery in teenagers has become popular in past decades because of an increase in self-awareness and desire to "fit in" with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are younger than 19 years. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scarce. The rationale for this article is to study this issue in depth by means of a systematic review. The authors discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery and make recommendations for future studies on this important area.

Comparing the efficacy of a brief self-esteem and self-compassion intervention for state body dissatisfaction and self-improvement motivation

This study explored the efficacy of reflective writing tasks for reducing state body dissatisfaction and improving self-improvement motivation. Participants (N = 153) were exposed to a threatening body image scenario, after which they reported their state body dissatisfaction. Following randomisation to one of three interventions (self-esteem, self-compassion, or positive distraction control), participants completed the state body dissatisfaction measures again along with a measure of self-improvement motivation. At post-intervention, state weight dissatisfaction and appearance dissatisfaction were significantly lower and self-improvement motivation was significantly higher in the self-compassion group than in both the self-esteem and control groups. Trait body dissatisfaction moderated the efficacy of the intervention whereby the benefit of the self-compassion intervention became evident at moderate levels of trait body dissatisfaction, and was most apparent at high levels of body dissatisfaction. Self-compassion was a robust and efficacious method through which to promote immediate improvements to bodily feelings and desire to self-improve.

School-based versus after-school delivery of a universal wellness programme - A randomized controlled multi-arm trial

Positive self-image and body image as well as high self-esteem and media literacy are considered protective factors against health-compromising behaviours. Investigation of the optimal setting for body image prevention programmes is important to maximize outcomes from such programmes. Most universal wellness programmes are school based and thus delivered to a "captive" population. Only a few reports have been published about wellness programmes delivered in after-school settings, and none of them compared delivery after school to delivery in a school-based setting.

AIMS

To assess the acceptability, feasibility and efficacy of an interactive wellness preventive programme (In Favour of Myself) when delivered in a school-based setting versus an after-school setting.

METHODS

A randomized controlled multi-arm trial with 224 adolescent girls aged 13-15 years old was conducted. There were 102 girls participating in the after-school setting and 102 girls in the school-based setting. The programme contained nine 90-minute lessons, delivered weekly over 2 months. An intention-to-treat assessment was performed three times: at baseline, at the programme's conclusion (two months) and at follow-up (3 months).

RESULTS

At programme termination and follow-up, the impact of In Favour of Myself was higher among participants in the after-school setting than in the school-based setting with respect to advertisement strategies, media pressure, gap between current and ideal body image, drive for thinness and self-esteem.

CONCLUSIONS

This study provides support for a community-led approach to promote health behaviours, an approach that currently is a significant feature of health improvement policy and practice.

An examination of risk factors that moderate the body dissatisfaction-eating pathology relationship among New Zealand adolescent girls

BACKGROUND

Eating disorders (EDs) and their subclinical variants are important health concerns for adolescent girls, and body dissatisfaction is a more common yet often debilitating experience that typically precedes the development of an ED. Despite this fact, little is known about what makes girls who are dissatisfied with their bodies more likely to engage in pathological eating behaviors. The present study explored eating pathology among a sample of adolescent girls from New Zealand and examined a variety of established risk factors that may moderate the relationship between body dissatisfaction (BD) and eating pathology.

METHODS

Adolescent girls aged between 14 and 18 (N = 231) completed questionnaires assessing eating pathology, BD, negative affect, perfectionism, self-esteem, teasing and sociocultural pressure. Regression analyses tested for moderator effects to examine which variables moderated the relationship between BD and eating pathology.

RESULTS

The analyses indicated that high levels of socially prescribed and self-oriented perfectionism, negative affect, perceived pressure from the media, and low levels of self-esteem all strengthened the relationship between BD and eating pathology.

CONCLUSIONS

The results highlight potential factors that may make adolescent girls who are dissatisfied with their bodies more susceptible to eating pathology.

Feasibility and acceptability of a prevention program for eating disorders (Me, You and Us) adapted for young adolescents in Korea

PURPOSE

The aim of this study was to assess the adaptability and acceptability of a prevention program.

METHODS

A total of 169 Korean students (83 boys and 86 girls) with a mean age of 12.3 years from a 6th grade class at an elementary school participated in the study. Mental health social workers delivered Me, You and Us, a school-based body image intervention program originally developed in the UK, through a set of six sessions. The participants were assessed in terms of their body satisfaction and self-esteem before the program, after the program, and at 1-month follow-up. They were also surveyed about their satisfaction and acceptability levels after the program.

RESULTS

At baseline, girls had lower body satisfaction and self-esteem than boys, and their body satisfaction and self-esteem improved after the program. The improved body satisfaction was maintained at the 1-month follow-up. The efficacy of the program on body satisfaction was positively correlated with the frequency of their baseline level of "fat talk." The program was more effective in girls with possible symptoms of an eating disorder at baseline. 93.7% of boys and 77.4% of girls responded that they enjoyed the program.

CONCLUSIONS

The program Me, You and Us was well-accepted by early adolescents in Korea and it can play a role in increasing body satisfaction and self-esteem by reducing "fat talk" in 6th grade students.

LEVEL OF EVIDENCE

Level III, cohort study with intervention.

Improved Self-Esteem in Artists After Participating in the "Building Confidence and Self-Esteem Toolbox Workshop"

Performing and creative artists have unique occupational and lifestyle stresses and challenges that can negatively affect self-esteem. Low self-esteem not only has serious implications for their psychological and physical health, it can also affect their performance, and creativity. There is a need to establish effective interventions to deal with this issue. To the best of our knowledge, there are no reported studies specific to workshops or interventions on enhancing self-esteem for artists. The Al and Malka Green Artists' Health Centre at the Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, is a unique multidisciplinary, and integrative clinic serving the special needs of the artist population. We developed a workshop entitled “Building Confidence and Self Esteem Toolbox Workshop” to address this need. We then designed a single-blind, randomized, prospective, pilot study to evaluate the effectiveness of the workshop on enhancing self-esteem in artists, and to evaluate the long-term effectiveness of using the recommended tools in maintaining a healthy self-esteem, as well as maintaining physical and emotional health. Both quantitative and qualitative data were collected. A validated “Self-Esteem Checkup” questionnaire was administered pre- and immediately post workshop, as well as at 2, 6, and 12 months post workshop. Open-ended questions were posed to study participants via email at 2 and 12 months following the workshop, and at 6 months in in-person interviews. Thirty-five professional artists consented to participate in the study, with 26 completing all study visits. Mean scores for all time points, and the individual questionnaire statement mean scores for the five timepoints increased significantly post-workshop and remained statistically significantly improved by the 3rd follow-up 12 months later (p < 0.001). The mean self-esteem rating score increased significantly post-workshop and remained statistically significantly improved by the 3rd follow-up 12 months later (p < 0.01). Qualitative data showed positive feedback on the utilization of the tools learned in the workshop that helped maintain this improvement over a 1-year period. This workshop may be an effective means of addressing the issue of self-esteem in artists. Further controlled studies of larger sample size and longer duration are needed to confirm these findings.

A novel educational intervention targeting melanoma risk and prevention knowledge among children with a familial risk for melanoma

OBJECTIVE

To examine the acceptability of and preliminary effects associated with a novel educational intervention for children at elevated risk for melanoma. The intervention incorporated information on mechanisms through which melanoma preventive behaviors mitigate risk for melanoma and was delivered to parents and children concurrently.

METHODS

Twenty-two parents (with a personal history of melanoma or spouse with a history of melanoma) and 33 children (mean age 11.8 years) were asked to complete questionnaires immediately prior to and after an educational session and at a one-month follow-up.

RESULTS

Both parents and children endorsed that the educational materials were acceptable. Knowledge about melanoma risk and preventive and screening behaviors increased significantly. Children's perceived risk for melanoma increased significantly, while parents' perceptions of children's risk started at a higher level and remained constant. There were significant increases in reported engagement in sun protective behaviors.

CONCLUSION

The educational intervention shows promise in terms of its acceptability and effects on participant knowledge, perceived risk, and engagement in melanoma preventive behaviors.

PRACTICE IMPLICATION

Children at elevated risk for melanoma and their parents may benefit from receiving educational information on their disease risk and strategies for prevention and screening.

Discrimination, mental health, and body image among transgender and gender-non-binary individuals: Constructing a multiple mediational path model

The purpose of the current study was to examine the relationships among discrimination, mental health, and body image in a national sample of transgender adults. Participants (N = 78) identified as transgender, genderqueer, or other gender non-binary identities and were recruited via a national online survey. Harassment/rejection, work/school, and other discrimination explained10.4% of the variance in body appreciation, while satisfaction with life, anxiety, self-esteem, and depression explained 60.7%. Within these models, harassment/rejection was inversely associated with body appreciation, while self-esteem and satisfaction with life were positively associated. A series of path models moving from a measurement model to a more parsimonious and excellent-fitting model found that the effect of harassment/rejection on body appreciation was fully mediated by self-esteem and satisfaction with life, resulting in a multiple mediation.

The effectiveness of self-compassion and self-esteem writing tasks in reducing body image concerns

This study investigated whether single-session self-compassion and self-esteem writing tasks ameliorate the body image concerns evoked by a negative body image induction. Ninety-six female university students aged 17-25 years (M_age=19.45, SD=1.84) were randomly assigned to one of three writing treatment groups: self-compassion, self-esteem, or control. After reading a negative body image scenario, participants completed scales measuring state body appreciation, body satisfaction, and appearance anxiety. They then undertook the assigned writing task, and completed the three measures again, both immediately post-treatment and at 2-week follow-up. The self-compassion writing group showed higher post-treatment body appreciation than the self-esteem and control groups, and higher body appreciation than the control group at follow-up. At post-treatment and follow-up, self-compassion and self-esteem writing showed higher body satisfaction than the control. The groups did not differ on appearance anxiety. Writing-based interventions, especially those that enhance self-compassion, may help alleviate certain body image concerns.

A pilot controlled trial of a cognitive dissonance-based body dissatisfaction intervention with young British men

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men's dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds=0.46-0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects.

Cross-cultural validity of the theory of planned behavior for predicting healthy food choice in secondary school students of Inner Mongolia

AIMS

Unhealthy eating behavior is a serious health concern among secondary school students in Inner Mongolia. To predict their healthy food choices and devise methods of correcting unhealthy choices, we sought to confirm the cross-cultural validity of the theory of planned behavior among Inner Mongolian students.

MATERIALS AND METHODS

A cross-sectional study, conducted between November and December 2014. Overall, 3047 students were enrolled. We devised a questionnaire based on the theory of planned behavior to measure its components (intentions, attitudes, subjective norms, and perceived behavioral control) in relation to healthy food choices; we also assessed their current engagement in healthy food choices.

RESULTS

A principal component analysis revealed high contribution rates for the components (69.32%-88.77%). A confirmatory factor analysis indicated that the components of the questionnaire had adequate model fit (goodness of fit index=0.997, adjusted goodness of fit index=0.984, comparative fit index=0.998, and root mean square error of approximation=0.049). Notably, data from participants within the suburbs did not support the theory of planned behavior construction. Several paths did not predict the hypothesis variables. However, attitudes toward healthy food choices strongly predicted behavioral intention (path coefficients 0.49-0.77, p<0.01), regardless of demographic characteristics.

CONCLUSION

Our results support that the theory of planned behavior can apply to secondary school students in urban areas. Furthermore, attitudes towards healthy food choices were the best predictor of behavioral intentions to engage in such choices in Inner Mongolian students.

A Systematic Review of the Effects of Resistance Training on Body Image

The purpose of this systematic review was to identify and appraise the literature that has specifically tested the independent effects of resistance training (i.e., weightlifting) on body image in adults. A comprehensive search of electronic databases PubMed, Scopus, PsycNET, and Web of Science for relevant studies published in peer-reviewed journals through December 2016 was conducted, and PRISMA guidelines were followed. Inclusion criteria were that a study had to be (a) written in English, (b) published in a peer-reviewed journal, (c) conducted an assessment of body image using a validated scale before and after a stand-alone resistance training intervention (i.e., not coupled with another mode of treatment), and (d) excluded participants younger than 18 years. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 7,324 studies were identified, and 11 were included in this review. The majority (8 of 11) of studies concluded that resistance training can significantly improve multiple dimensions of body image, including body satisfaction, appearance evaluation, and social physique anxiety; however, only 3 studies were considered high quality based on their PEDro score, and several methodological limitations exist. Overall, resistance training seems to have the potential to improve body image in adults, but future high-quality studies with more rigorous testing methods and study designs are needed.

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Background

Anorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.

Objectives

This programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.

Methods

WP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.

Results

WP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.

Conclusions

This programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.

Trial registration

Current Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.