Weight-related and shape-related self-evaluation in eating-disordered and non-eating-disordered women

Potential eating disorder exhibited with daytime functional vulnerabilities associated with sleep problems in Japanese adolescents: A cross-sectional study

OBJECTIVES

Eating disorders (ED) are serious psychiatric disorders that affect individuals, especially adolescents. It has been suggested that nonclinical ED-like characteristics are related to sleep problems. We conducted a survey of Japanese adolescents to investigate this claim.

METHOD

In this cross-sectional study, 398 adolescents aged 12-18 years responded to a self-administered questionnaire survey. We used the Eating Attitudes Test-26 (EAT-26) and the Athens Insomnia Scale (AIS) to measure potential ED and sleep problems, respectively.

RESULTS

Adolescents with potential ED had significantly higher daytime functional vulnerability potentially associated with sleep problems than those without ED. In particular, problems with a sense of well-being and physical and mental functioning during the day were significant. In contrast, no significant associations were found between potential ED and sleep initiation, awakenings during the night, early morning awakening, total sleep duration, or overall quality of sleep. Finally, nocturnal and daytime sleep scores were significantly associated with dieting, bulimia, and oral control EAT-26 subscores.

DISCUSSION

Participants with possible ED experienced problems related to well-being and mental and physical functioning, which are indicators of daytime functional vulnerability potentially associated with sleep problems. Further, adolescents with more severe ED characteristics are more likely to have a higher degree of daytime psychological vulnerability potentially attributable to sleep problems. The study suggested that professionals treating adolescent mental health issues need an approach that comprehensively integrates both sleep problems and potential ED.

Getting a head start: identifying pretreatment correlates associated with early weight loss for individuals participating in weight loss treatment

Early weight loss is associated with greater weight loss following treatment cessation and years later. The present study aimed to identify pretreatment correlates associated with early weight loss in adults participating in weight-loss treatment in primary care. Participants (N = 89) were in the overweight/obesity range seeking weight-loss treatment in primary-care settings and randomized to one of three treatments: Motivational Interviewing and Internet Condition (MIC), Nutrition Psychoeducation and Internet Condition (NPC), or Usual Care (UC). At baseline, participants were assessed with the Eating Disorder Examination (EDE) interview and completed self-report measures of emotional overeating, exercise, exercise self-efficacy, and depression. Percent weight loss at week six was used as the Early Weight Loss variable. MIC/NPC groups had significantly greater Early Weight Loss than UC. Among MIC/NPC participants only, greater Early Weight Loss was associated with significantly lower pretreatment disordered eating and depressive symptoms. Participants in MIC/NPC who achieved clinically meaningful weight loss (>2.5%) by week six compared with those who did not (<2.5%) reported lower pretreatment disordered eating. Demographic factors and binge-eating disorder diagnosis were unrelated to Early Weight Loss. Our findings suggest that greater early weight loss may be associated with less pretreatment disordered eating and depressive symptoms.

CLINICAL TRIALS

NCT01558297.

The Causal Influence of Life Meaning on Weight and Shape Concerns in Women at Risk for Developing an Eating Disorder

Background: Although previous studies have shown an inverse relation between life meaning and eating disorder symptoms, the correlational nature of this evidence precludes causal inferences. Therefore, this study used an experimental approach to test the causal impact of life meaning on individuals' weight and shape concerns. Methods: Female students at risk for developing an eating disorder (N = 128) were randomly assigned to the control or the meaning condition, which involved thinking about and committing to pursue intrinsically valued life goals. A color-naming interference task was used to assess the motivational salience of body-related stimuli, and self-report measures were used to assess participants' overvaluation of weight and shape. Results: The meaning manipulation was effective in activating intrinsically valued life goals. However, it did not result in lower self-reported overvaluation of weight and shape or lower color-naming interference effects of body-related stimuli, compared to the control condition. Post-hoc analyses suggested that baseline meaning in life was related to the impact of the manipulation. Conclusions: This experimental study did not provide evidence for a causal influence of life meaning on the overvaluation of weight and shape in a high-risk group. The current findings suggest that we first need to examine the relationship between life meaning and eating disorder symptoms in more detail, before implementing brief meaning manipulations in clinical practice.

The Influence of Weight-Related Self-Esteem and Symptoms of Depression on Shape and Weight Concerns and Weight-Loss 12 Months After Bariatric Surgery

INTRODUCTION

While body image can improve following bariatric surgery, a portion of patients continue to experience concerns about weight and shape regardless of weight lost. Research is needed to identify risk factors for post-surgical weight and shape concerns given that body dissatisfaction may contribute to poor outcomes.

AIMS

To evaluate whether (1) change in weight-related self-esteem and symptoms of depression from pre- to 12-month post-surgery were associated with change in weight and shape concerns independent of weight-loss; (2) improvement in weight and shape concerns, symptoms of depression, and/or weight-related self-esteem predict greater weight-loss 12 months after bariatric surgery; and (3) improvements in weight-related self-esteem, symptoms of depression, weight concerns, or shape concerns predict weight loss.

METHODS

Fifty adults approved to receive bariatric surgery self-reported body mass index and completed validated measures of weight-related self-esteem, symptoms of depression, and weight and shape concerns pre- and 12-month post-surgery.

RESULTS

Improvements were observed for weight-related self-esteem, concerns over shape and weight, symptoms of depression, and body mass index from pre- to 12-month post-surgery. Improvement in weight-related self-esteem was associated with concomitant improvements in concerns over shape and weight, independent of weight loss. Improvement in symptoms of depression was associated with improvement in concerns over weight, but not shape. Finally, exploratory analyses indicated that improvements in weight-related self-esteem, and concerns over shape and weight, but not symptoms of depression were associated with improvement in weight-loss.

CONCLUSIONS

Weight-related self-esteem may represent an overlooked and important target throughout the bariatric surgery process that could enhance surgical outcomes.

Overvaluation of Weight or Shape and Loss-of-Control Eating Following Bariatric Surgery

OBJECTIVE

Little is known regarding overvaluation of weight or shape, a key cognitive feature of eating disorders, among individuals with disordered eating following bariatric surgery. This study examined the significance of overvaluation of weight or shape among post-bariatric surgery patients with loss-of-control (LOC) eating.

METHODS

Participants were 145 individuals who had undergone sleeve gastrectomy within the previous 6 months and reported regular LOC eating. Overvaluation of weight or shape, LOC eating, and eating disorder psychopathology were assessed using the Eating Disorder Examination (EDE)-Bariatric Surgery Version interview; depressive symptoms and disability were assessed by the Beck Depression Inventory (BDI-II) and the Sheehan Disability Scale (SDS), respectively.

RESULTS

Overvaluation of weight or shape, examined continuously, was correlated significantly with higher levels of eating disorder psychopathology (EDE), depression (BDI-II), and disability (SDS). Categorically, using established clinical cut points, relative to the subclinical overvaluation group (n = 70 [48.3%]), the clinical overvaluation group (n = 75 [51.7%]) reported significantly greater frequency of LOC eating episodes and higher EDE, BDI-II, and SDS scores. The two groups did not differ significantly in current BMI or percent weight loss following surgery.

CONCLUSIONS

These findings, which highlight the clinical significance of overvaluation of weight or shape among patients with LOC eating following bariatric surgery, are similar to those previously reported for binge-eating disorder. Postoperatively, overvaluation of weight or shape was associated with greater eating disorder psychopathology, depression, and disability.

Do thoughts about dieting matter? Testing the relationship between thoughts about dieting, body shape concerns, and state self-esteem

BACKGROUND AND OBJECTIVES

Dieters are likely primed to think about their diet throughout the day (e.g., as they feel hungry). However, prior research has not tested whether and how thinking about dieting might have negative effects, like poor self-esteem and body shape concerns.

METHODS

We experimentally primed dieters' thoughts about their diets and tested whether: 1) dieting thoughts are related to poor state self-esteem through body shape concerns; and 2) dieting thoughts are related to body shape concerns through poor state self-esteem. Dieting participants (N = 225) were randomly assigned to complete a dieting or neutral prime.

RESULTS

Unexpectedly, there was a different pattern of results across male (n = 72) and female (n = 144) dieters. When accounting for body shape concerns, males primed to think about dieting (vs. neutral condition) reported greater state self-esteem. Further, the dieting prime indirectly led to lower body shape concerns through greater state global self-esteem. However, for females, the dieting prime indirectly led to poorer state self-esteem through its effects on body shape concerns.

LIMITATIONS

The sample was collected online and was predominantly female and Caucasian. Other limitations include self-report of dieting status and body mass index.

CONCLUSIONS

The findings suggest that for males, thoughts about dieting may actually be associated with greater state self-esteem, which may indirectly predict lower body shape concerns. In contrast, for females, when thoughts about dieting activate body shape concerns, poorer state self-esteem may follow. These results highlight important, potentially gender-specific relationships between thoughts about dieting, body shape concerns, and state self-esteem.

Does psychological well-being change following treatment? An exploratory study on outpatients with eating disorders

Psychological well-being changes following cognitive-behavioral therapy-based treatment were investigated in outpatients with eating disorders (ED). While it is known that CBT reduces symptomatology in EDs, less is known about how changes in positive functioning may ensue. One-hundred and eighty five ED outpatients were analyzed for pre-treatment and post-treatment changes in psychological well-being (PWB) by last observation carried forward - Wilcoxon signed rank tests. Significant gains in all PWB dimensions were found, with moderate effect size correlations in environmental mastery (r=-.418), personal growth (r=-.351) and self-acceptance (r=-.341). A subsample of patients in remission (n=51) was selected and compared to healthy controls in PWB post-treatment scores through Mann-Whitney U tests. Remitted patients showed significantly lower psychological well-being in two dimensions compared to controls: PWB-positive relations (r=-.360) and PWB-self-acceptance (r=-.288). However, more than 50% of ED outpatients in remission had PWB scores that fell below the 50th percentile of healthy controls in all psychological well-being dimensions, despite significant treatment response. Several mechanisms of psychological well-being change following CBT-based treatment are discussed. The assessment of treatment outcome in EDs may benefit from considering changes in positive functioning such as psychological well-being, in addition to the standard measurement of BMI, symptomatology and behavioral parameters. CBT-based treatment outcomes may be strengthened by promoting the development of optimal domains particularly in the interpersonal realm, such as building of quality and warm relationships and focusing on enhancing self-acceptance.

"That camera adds ten pounds!:" women's reactions to visual weight-related feedback and the role of trait body checking

In Study 1 women were randomly assigned to viewing: (1) no photo of themselves, (2) an accurate, full-body photo, (3) a photo modified to make them appear thinner than usual, or (4) a photo modified to make them appear heavier than usual. Measures of mood, state self-esteem, and body dissatisfaction were completed. There were no main effects of photo condition; participants were generally poor at perceiving weight change. The heavier that participants thought they looked in their photo as compared to usual, the worse their appearance self-esteem and body dissatisfaction. Study 2 replicated these results and found that participants with higher levels of trait body checking were more likely to report that they looked heavier than usual in the photo. Study 3 replicated these results and found that the correlation between body parts checking and how participants thought they looked in the photo held true even after controlling for appearance investment.

The Weight Influenced Self-Esteem Questionnaire (WISE-Q): factor structure and psychometric properties

Weight-based self-esteem (WBSE) is hypothesized to be the core cognitive feature of eating disorders. The Weight Influenced Self-Esteem Questionnaire (WISE-Q) was designed to measure the influence of a negatively perceived body image on multiple dimensions of self-esteem, which we believe to be one aspect of WBSE. Study 1 sought to determine the factor structure of the WISE-Q as well as to examine the reliability and concurrent validity of WISE-Q scores among eating disorder and undergraduate student participants. In Study 2, validity was further investigated by examining changes in WISE-Q scores with treatment. The WISE-Q has two factors representing generalized and expected WBSE. Evidence of internal and test-retest reliability was found. Also, the pattern of correlations between WISE-Q scores and other constructs was in line with predictions. As expected, WISE-Q scores improved with treatment yet remained high.

Overvaluation of shape and weight among overweight children and adolescents with loss of control eating

Little is known about the phenomenology of pediatric loss of control (LOC) eating. Overvaluation of shape and weight, however, appears to be diagnostically meaningful among binge eating adults. We explored the significance of shape and weight overvaluation among children and adolescents with LOC eating. Participants (n = 526) included 149 overweight youth with LOC eating and 377 overweight controls (CON). Participants were categorized as those reporting at least moderate overvaluation (LOC-Mod, n = 74; CON-Mod, n = 106) or less than moderate overvaluation (LOC-Low, n = 75; CON-Low, n = 271), and compared on measures of eating-related and general psychopathology. LOC-Mod evidenced lower self-esteem than CON-Low, and greater behavioral problems than CON-Mod and CON-Low, but did not differ from LOC-Low in these domains. With the exception of LOC-Low and CON-Mod, all groups differed on global eating-disorder severity, with LOC-Mod scoring the highest. Overvaluation of shape and weight appears to be of questionable importance in defining subtypes of youth with LOC eating. However, as overvaluation and LOC eating each independently predicts eating-disorder onset, their confluence may confer even further risk for eating-disorder development. Longitudinal studies should address this possibility. Developmentally appropriate discussion about body image disturbance may be indicated in interventions targeting pediatric LOC eating and/or obesity.

The undue influence of shape and weight on self-evaluation in anorexia nervosa, bulimia nervosa and restrained eaters: a combined ERP and behavioral study

BACKGROUND

Current theories and nosology assume that the self-evaluation (SE) of individuals with eating disorders (EDs) is unduly influenced by body shape and weight. However, experimental data supporting this link are scarce, and it is not specified which subdomains of SE might be affected.

METHOD

We studied patients with anorexia nervosa (AN), bulimia nervosa (BN) and healthy controls (HC) with an affective priming (AP) procedure (Study 1) to unveil explicit and implicit associations between shape/weight and SE. We used weight/shape-related prime sentences, complemented by affectively congruent and incongruent target words from two SE domains. AP effects were assessed by event-related potentials (ERPs), reaction times (RTs) and subjective ratings. The ratings were also assessed (Study 2) in undergraduate restrained (RES) and unrestrained eaters (UNRES).

RESULTS

Study 1 demonstrated stronger AP effects in both ED groups compared to HC on RTs and subjective ratings. ERPs showed AP effects only in the BN group. Restrained eaters showed similar, albeit less pronounced, priming effects on subjective ratings.

CONCLUSIONS

ED patients associate shape/weight concerns with the non-appearance-related SE domains of interpersonal relationships and achievement/performance. These associations seem to be encoded deeper in BN patients relative to the other groups. Links between shape/weight and SE explain how body dissatisfaction impacts on self-esteem and mood in ED. The existence of similar associations in restrained eaters supports a continuum model according to which increasing associations between shape/weight and SE go along with increasing levels of ED symptoms.

Characteristics measured by the Eating Disorder Inventory for children at risk and protective factors for disordered eating in adolescent girls

OBJECTIVE

The aim of this study was to examine longitudinally the role of characteristics measured by the Eating Disorder Inventory-Child version (EDI-C) to find early predictors that might constitute risk and protective factors in the development of disordered eating.

METHOD

Participants were divided into three groups based on eating attitudes at T2: disordered eating (n = 49), intermediate eating concern (n = 260), and healthy eating attitudes (n = 120). EDI-C from T1 (four to five years earlier) was then analyzed to find predictors of group classification at T2.

RESULTS

Drive for thinness and body dissatisfaction emerged as risk factors at T1, while drive for thinness, body dissatisfaction, and interoceptive awareness emerged as protective factors after controlling for initial eating concerns and body mass index.

DISCUSSION

Eating disorders should not be seen as a result of a premorbid personality type. Rather we should take a more social-psychological perspective to explain how individual and sociocultural factors work together in the development of these conditions.

The significance of overvaluation of shape and weight in binge eating disorder

As publication of DSM-V draws near, research is needed to validate the diagnostic scheme for binge eating disorder (BED). Shape and weight overvaluation has stimulated considerable debate in this regard, given associations with psychosocial impairment and poor treatment outcome in BED. This study sought to further explore the convergent validity and diagnostic specificity of shape and weight overvaluation in BED. A total of 160 women with BED, and 108 women with non-eating disordered psychiatric disorders were recruited from the community. Women with BED were classified as more or less severe based on a global measure of eating-related psychopathology; subsequent receiver operating characteristics analysis determined that a threshold of at least "moderate" overvaluation best predicted membership into a more severe group. BED participants with threshold overvaluation exhibited poorer psychosocial functioning than those with subthreshold overvaluation, as well as participants with other psychiatric disorders. Discriminant function analysis revealed that threshold overvaluation predicted a diagnosis of BED versus other psychiatric disorder with 67.7% accuracy. Results suggest that shape and weight overvaluation is a useful diagnostic specifier in BED. Continued research is warranted to examine its predictive validity in natural course and treatment outcome studies.

Hypnotic alteration of body image in the eating disordered

A driving force in an eating disorder like anorexia nervosa has been a distorted body image. The psychobiological dynamics of eating disorders have demonstrated significant hypnotic phenomena such as forms of dissociation, hallucination, time distortion and catalepsy, and therefore, pose hypnosis as a good fit for particular parts of treatment. Presented here are four hypnotic approaches designed to inspire the establishment of a reality based body image in the eating disordered individual. Conditional prerequisites for application of these interventions are described and case examples illustrate each approach. A discussion on some of the rationale for formulating these strategies is offered.

State self-esteem ratings in women with bulimia nervosa and bulimia nervosa in remission

OBJECTIVE

Bulimia nervosa (BN) is associated with low self-esteem. This study was designed to assess whether low self-esteem persists in nondepressed individuals who have recovered from BN (BN-R).

METHOD

Study groups included BN (n = 22), BN-R (n = 20), and healthy controls (n = 42). Participants were medication-free, and none met criteria for current major depression. Assessment instruments included the State Self-Esteem Scale (SSES), a self-rating scale designed to measure state-related changes in self-esteem.

RESULTS

Consistent with previous reports, SSES scores for BN were lower than for controls (p < .001). For BN-R, SSES scores were higher than for BN (p < .001), but lower than for controls (p < .025). For BN-R, scores on the SSES Appearance subscale were inversely correlated with ratings of dietary restraint (p < .005).

CONCLUSION

This study provides new evidence for persistent low self-esteem following recovery from BN. Follow-up studies are needed to assess whether low self-esteem contributes to recurrent dieting and risk for relapse.

Does regional brain perfusion correlate with eating disorder symptoms in anorexia and bulimia nervosa patients?

OBJECTIVE

Using single photon emission computed tomography (SPECT), we sought brain perfusion correlates of eating disorder symptoms in anorexia and bulimia nervosa patients.

METHOD

We investigated 67 female eating disordered (ED) patients. Eating disorder symptoms were measured by the Eating Disorders Inventory (EDI). Determination of brain areas in which regional perfusion co-varied with drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness and maturity fears was done by open explorative correlation analysis using Statistical Parametrical Mapping (SPM).

RESULTS

A significant positive correlation between scores on body dissatisfaction and ineffectiveness, and brain perfusion in the prefrontal and parietal cortex was demonstrated. There were no correlations between other eating disorder symptoms and brain perfusion.

CONCLUSION

Based on the finding of an association between regional brain flow and body dissatisfaction and ineffectiveness, we argue that neurobiological findings in ED patients may not only reflect emotional and behavioural factors but cognitive-evaluative features as well.

Thin-ideal internalization, body dissatisfaction and symptoms of eating disorders in Croatian adolescent girls

The aim of this investigation was to study the relationship between unhealthy eating habits and behaviors, perception and acceptance of societal standards regarding thinness, body dissatisfaction, and family and peer pressure to be thin. One hundred and twentythree high school girls from Rijeka (Croatia) were surveyed using Eating Attitudes Test (EAT- 26), Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ), Body Esteem Questionnaire for Adolescents and Adults (BES), and Scale of perceived pressure to be thin from family and peers. The results of path analyses showed that social pressure from family and peers, experience of weight-related teasing and criticism by family members, contributed to development of eating disturbance. The acceptance of social standards related to appearance, contributed to onset of disturbed eating habits. Weight satisfaction alone influences the development of some eating disorder symptoms, but it is also a mediator of higher body mass index (BMI) and internalization of societal appearance standards. Girls with higher BMI, who accepted societal standards of thin-ideal, perceived major social pressure to be thin through direct and persuasive comments designed to establish the importance of dieting, and probably develop eating disturbed habits, or some symptoms of anorexia (AN) or bulimia nervosa (BN).

Relationship between binge-eating episodes and self-perception of body weight in a nonclinical sample of five Brazilian cities

OBJECTIVE

To investigate the relationship between binge-eating episodes and a perception that body weight is above the ideal in a sample of customers interviewed at shopping malls in five Brazilian cities.

METHODS

In 1999, data were collected over the course of one week (Monday-Friday only) at the largest shopping malls in the cities of Porto Alegre, Salvador, Fortaleza, Goiânia and Curitiba (two malls per city). A total of 2855 participants (917 men and 1938 women) were interviewed. Weight and height measurements were standardized. Binge-eating episodes were identified using a questionnaire including the following questions based on DSM-IV diagnostic criteria: "Have you ever eaten, in a period of two hours or less, an amount of food greater than that most people would eat?" and "If the answer was "yes", did you, during these episodes, feel unable to stop eating or to control how much you were eating?".

RESULTS

The prevalence of binge-eating episodes was higher among overweight subjects (15.6%) compared with normal-weight subjects (9.9%) (p = 0.0001) and, among subjects who perceived their body weight to be above the ideal (men: 13.9%; women: 15.1%) compared with those who perceived their body weight to be ideal or below the ideal (men: 8%; women: 7%) (p < 0.0001). In the multivariate analysis adjusted for body mass index and demographic variables, binge-eating episodes were correlated with the perception that body weight is above the ideal only among women (OR: 1.8; 95% CI: 1.2-2.5).

CONCLUSIONS

These findings suggest that the perception that body weight is above the ideal, regardless of overweight status, is associated with binge-eating episodes in women.

Weight-related other evaluation in eating disorders

Weight-related self-evaluation has been described as the fundamental maladaptive cognitive feature of disordered eating. It is not clear, however, whether the process of determining personal-worth based on an evaluation of body size is specific to the self, or whether it is relevant to the evaluation of people in general. Thirty-three eating disordered patients and 54 undergraduates read an article about a woman who was described as either overweight or slender and evaluated the woman on several dimensions. Both undergraduates and eating disordered patients rated the heavy woman as less attractive than the thin woman. However, the patients' evaluation of the overweight target's attractiveness was significantly more negative than the undergraduates'. Patients also rated the overweight woman as less popular and claimed that they liked the overweight woman less than the thin woman. These effects were not present among the undergraduate students. Finally, the eating disorder participants rated the overweight woman as more overweight and less intelligent than did the undergraduate students. The results suggest that weight-related evaluation in eating disorders extends beyond the self to include the evaluation of other people.

Body Weight and Body Image

HEALTH ISSUE: Body weight is of physical and psychological importance to Canadian women; it is associated with health status, physical activity, body image, and self-esteem. Although the problems associated with overweight and obesity are indeed serious, there are also problems connected to being underweight. Weight prejudice and the dieting industry intensify body image concerns for Canadian women and can have a major negative impact on self-esteem. KEY FINDINGS: Women have lower BMIs than men, a lower incidence of being overweight and a higher incidence of being underweight. However, women across all weight categories are more dissatisfied with their bodies. Sixty percent of women are inactive, and women with a BMI of 27 or higher are more likely to be inactive than women with lower BMIs. The data show that women are aware of the health benefits of exercise, but there is a gap between knowledge and practice. When asked about barriers to health improvement, 39.7% of women cited lack of time and 39.2% lack of willpower. DATA GAPS AND RECOMMENDATIONS: Weight prejudice must be made unacceptable and positive body image should be encouraged and diversity valued. Health policies should encourage healthy eating and healthy activity. Health curricula for young students should include information about healthy eating, active lifestyle, and self-esteem. Physical activities that mothers can participate in with their families should be encouraged. Research should be funded to elucidate the most effective methods of getting women to become and remain physically active without focusing on appearance.

Is beauty in the eye of the beholder? Effects of weight and shape on attractiveness ratings of female line drawings by restrained and nonrestrained eaters

This study tested the differences between restrained and nonrestrained eaters' attractiveness perceptions of female line drawings, of their own figures, and the ideal female figure. Female line drawings varied systematically in body weight and in waist and hip circumference. Forty-six female undergraduate students, 23 nonrestrainers and 23 restrainers, rated stimuli in attractiveness, identified the figure which best represented their own body type (PAF), and the ideal body figure (IF) according to the Restraint Scale [RS; Herman, C. P., & Polivy, J. (1980). Restrained eating. In: A. Stunkard (Ed.), Obesity (pp. 208-225). Philadelphia, PA: Saunders]. Restrainers did not generally differ from nonrestrainers in attractiveness ratings or in their choice of IF. However, differences between IF and PAF were larger in restrainers than in nonrestrainers because restrainers chose PAFs with larger hips than nonrestrainers did. This difference between the restraint groups was independent of between-group differences in hip size. This discrepancy between IF and PAF may contribute to the restrainers' motivation to diet.

Changes in body image during cognitive-behavioral treatment in women with bulimia nervosa

The purposes of this study were: (1) to examine multidimensional aspects of body image of individuals with bulimia nervosa (BN) at pre-treatment, post-treatment, and at follow-up, compared to a group of participants without BN; and (2) to investigate whether measures of body image predicted outcome at post-treatment and follow-up. The clinical sample consisted of 109 females with BN who were enrolled in a 12-week cognitive-behavioral group treatment program. Participants were assessed at baseline, at the completion of treatment, and at 1- and 6-month follow-up visits. The 82 females who comprised the non-bulimic sample were assessed at comparable time intervals. At baseline, the participants with BN reported greater body dissatisfaction and overestimated body size to a significantly greater degree than the comparison group, and reported a significantly smaller ideal size relative to perceived size. Results at the end of treatment indicated significant improvement in self-reported attitudinal disturbance and size overestimation, with continued reductions at follow-up. Logistic regression analyses did not demonstrate a predictive relationship between body image measures at baseline and outcome at post-treatment or follow-up, or between post-treatment and follow-up. Implications for treatment include specifying the source of body image-related distress and enhancing treatment efforts for perceptual and attitudinal aspects of body image.

Differences between women with anorexia nervosa and restrained eaters on shape and weight concerns, self-esteem, and depression

OBJECTIVE

The current study examined the relation among shape and weight concerns, domain-specific self-esteem, dietary restraint, and depression.

METHOD

Women with anorexia nervosa (AN; n = 19), restrained eaters (n = 20), and unrestrained eaters (n = 21) completed measures of shape and weight concerns, depression, and self-esteem.

RESULTS

Women with AN had significantly higher shape and weight concerns and lower self-esteem than restrained eaters. However, once depression was controlled, these significant differences disappeared on all but the morality self-esteem subscale. Unrestrained eaters had significantly lower shape and weight concerns and higher self-esteem than restrained participants both before and after depression was controlled.

DISCUSSION

Shape and weight concerns and low self-esteem are associated with dietary restriction. However, results from the current study suggest these two variables may not be the primary driving forces behind extreme dietary restriction.

Eating disorder behavior in physically active Norwegian women

Competitive female athletes may have higher risk of eating disorders (ED) than recreational athletes, in part because low body fat may be advantageous in sports. However, women who participate in sports or physical activities might also do this for weight reduction, altering body shape, and for other food related reasons. This study was conducted to evaluate the association between hours of leisure time physical activity (PA) and prevalence of ED, and whether the association between the Eating Disorders Inventory (EDI) scales and ED, as classified by the Survey of Eating Disorders (SED), was the same among women with high vs. low physical activity levels. The community-based study sample consisted of 898 female students aged 18-50 years. Subjects filled out the EDI, the SED, and a questionnaire concerning physical activity and demographic data. Physical activity was not associated with increased risk of having a SED-defined diagnosis of an ED or of having an EDI score greater than 40, which is sometimes used to define women at risk for having an eating disorder. Women with a SED-defined ED had higher scores on all subscales of the EDI, but did not differ with respect to age, BMI or hours of weekly activity. The strongest predictors of having a SED-defined ED were body mass index (BMI), two EDI scales, drive of thinness and Bulimia Nervosa, with no differences between the two PA groups. Among women with a SED-defined ED, those with more than 5 h weekly PA did not differ from others with respect to scoring on the EDI or BMI. Results suggest that hours of physical activity may not increase risk of developing ED. Effective interventions are needed to help the growing numbers of persons with body-image and eating difficulties. For some, moderate physical training might be helpful.