The tripartite influence model of body image and eating disturbance: a replication with a Japanese sample

Pursuing beauty: socio-cultural and labor-economic determinants of cosmetic surgery consideration among female college students in China

BACKGROUND

Cosmetic surgery has a profound impact on health and other aspects. As a means of enhancing physical attractiveness, it is increasingly being considered by female college students in China. However, current knowledge about the determinants of cosmetic surgery consideration among Chinese female college students still needs to be improved due to the lack of systematic perspectives and large-scale representative data sets. This study aimed to contribute to the literature in these two aspects.

METHODS

We framed cosmetic surgery consideration as a function of two broad sets of determinants: socio-cultural and labor-economic. We used data from a large, nationally representative sample of female college students in China (N = 6658, mean age = 20.3 years).

RESULTS

In terms of socio-cultural oriented factors, we found that family socioeconomic status, peers' cosmetic surgery practices, and media exposure were positively associated with the likelihood of considering cosmetic surgery. In terms of labor-economic oriented factors, we found that self-rated physical appearance, higher grades, and expected income after graduation were positively associated with a higher likelihood of considering cosmetic surgery.

CONCLUSIONS

These findings suggest that the decision-making process for cosmetic surgery among Chinese female college students goes beyond personal factors and is significantly influenced by structural factors.

Exploring Sociocultural Influences Affecting Body Image in Survivors of Childhood Sexual Assault

This phenomenological study explored the lived experiences of survivors of childhood sexual assault, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. Utilizing a social constructivist framework, the research team interviewed eleven (n = 11) participants from a variety of backgrounds who were gender assigned female at birth and had survived childhood sexual assault (CSA). Four major themes emerged from the narratives collected. These include sociocultural impacts which included four subthemes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences; meaning making of the critical event, i.e., childhood sexual assault; self-perception of their bodies; internal processes that have shaped their perceptions and meaning making, i.e., thoughts, feelings, and behaviors. Findings indicate major influence of sociocultural factors in shaping participant's internal processes as survivors of CSA, meaning making, and subsequently self-perceptions of, and relationship with, their bodies. We discuss CSA and body image keeping the intersectionality of the individual, their experiences, and the impact of sociocultural contexts on that intersectionality.

Chinese TikTok (Douyin) challenges and body image concerns: a pilot study

BACKGROUND

Social media content on Western platforms promoting thinness, or thinspiration, has been found to negatively affect body image perception of users. Less is known about non-Western social media use and its effects on body image concerns. Chinese TikTok, known as Douyin, is a popular short video platform with 600 million daily active users. Recent trends on Douyin encourage users to demonstrate thinness through participation in 'body challenges'. This paper argues that such content is comparable to thinspiration, however, to date hardly any research has been undertaken on these challenges. Thus, this pilot study aimed to analyse the content of three viral challenges and investigate their impact on Douyin users.

METHODS

Thirty most viewed videos were collected for three challenges (N = 90): the Coin challenge, the A4 Waist challenge, and the Spider leg challenge. Videos were coded for variables relating to thin idealisation, including thin praise, sexualisation and objectification, and analysed through content analytic methods. Video comments (N ≈ 5500) were analysed through thematic analysis, and main themes were identified.

RESULTS

Preliminary findings showed that participants who objectified their bodies to a greater extent expressed more negative body image concerns. In addition, comments on the videos had themes of thin praise, self-comparison, and promotion of dieting behaviours. In particular, videos of the A4 Waist challenge were found to incite more negative self-comparison in viewers.

CONCLUSION

Preliminary findings suggest all three challenges promote the thin ideal and encourage body image concerns. Further research about the broader impact of body challenges is needed.

Integrating social media variables as predictors, mediators, and moderators within body image frameworks: Potential mechanisms of action to consider in future research

In this article, we consider how social media variables may be integrated as predictors, mediators, and moderators within dominant theoretical frameworks of body image in order to identify potential mechanisms of action that can be empirically examined in future research and used to direct prevention and intervention efforts. To achieve this goal, we first articulate social media variables that have been investigated as predictors, mediators, and moderators in body image research. Next, we present the following critical and sociocultural theoretical frameworks: social comparison theory, tripartite influence model, objectification theory, developmental theory of embodiment, acceptance model of intuitive eating, cultivation theory, and uses and gratifications theory. Additionally, we present the theory of development of critical body awareness, a newly developed model that may provide further insight regarding the relationships between social media and body image-related outcomes. For each model, we articulate extant research that has explored social media variables within its context and explicate how social media variables could potentially be studied as predictors, mediators, and moderators within its structure. To conclude, we address pertinent limitations and gaps within this research space that could direct future research across the theoretical frameworks.

How prepartum appearance-related attitudes influence body image and weight-control behaviors of pregnant Japanese women across pregnancy: Latent growth curve modeling analyses

A thin female physique is idealized in modernized societies, leading many pregnant women to experience body dissatisfaction and avoid weight gain, as pregnancy directs their body away from the sociocultural ideal of thinness. However, not all pregnant women report body dissatisfaction and/or weight-control behavior. We aimed to discern how prepartum weight-related attitudes-thin-ideal internalization, drive for thinness, and appearance comparison tendency-influence changes in negative attitudes toward a pregnant body, body image, and weight-control behavior across pregnancy. Data were longitudinally collected from 208 Japanese pregnant women (Mage = 27.0, SD = 1.74) across three pregnancy periods. Results indicated that overall, negative attitudes toward appearance change during pregnancy, weight-control behaviors, and restrained eating significantly changed across pregnancy. Moreover, those with higher prepartum thin-ideal internalization showed greater decreases in negative attitudes toward appearance change during pregnancy and greater increases in body dissatisfaction, whereas those with higher prepartum drive for thinness and appearance comparison tendency showed greater decreases in restrained eating across pregnancy. Our findings suggest that pregnant women with certain prepartum weight-related attitudes may experience an aggravation of body dissatisfaction while following dietary regimen during pregnancy. Thus, prevention programs may selectively help them reduce their negative body image during pregnancy.

Body image as a global mental health concern

Body image concerns related to weight or other dimensions of appearance are now prevalent on a global scale. This paper reviews the theoretical frameworks that account for the global similarities and regional differences in rates and presentation of body image concerns, as well as reviewing the extant data. Given the harmful consequences of body image concerns in terms of mental and physical health, their global burden is high. Interventions to mitigate these concerns at the individual and systemic level are warranted.

Social comparison, disordered eating, and body dissatisfaction among postpartum women

The postpartum period is a window of vulnerability for disordered eating. Postpartum women experience pressures to "bounce back" to their pre-pregnancy weight which may lead to social comparisons, however it is unknown what postpartum women compare (e.g., body, eating), and to whom they compare themselves (e.g., celebrities, peers). This study evaluated links between different types (what is compared) and sources (to whom do they compare) of social comparison that postpartum women engage in. Included was self-oriented comparison, a novel construct conceptualized as comparisons of one's current postpartum appearance to one's pre-pregnancy appearance. A total of 306 postpartum women who gave birth in the past year and 153 control women who had never been pregnant completed an online survey. Results demonstrated postpartum women engaged in more frequent self-oriented comparison than controls. Postpartum women compared their bodies more frequently to their pre-pregnant selves, than to other sources. Although all types and sources of comparison were positively correlated with each disordered eating construct, eating comparison and self-oriented body comparison emerged as the dominant types and sources of comparison explaining unique variance in a range of disordered eating. Results suggest social comparison factors may be critical in understanding postpartum disordered eating risk.

Integrating fear of fatness into sociocultural models of body image and eating concerns

To date, sociocultural models of body dissatisfaction and disordered eating have predominantly focused on the pursuit of thinness and have somewhat neglected sociocultural discourse and pressures that increase fear of fatness. Therefore, we tested a model to determine whether sociocultural pressures from media and interpersonal sources were associated with drive for thinness and fear of fatness. We also examined whether beliefs about the controllability of shape and weight were in turn associated with body dissatisfaction and disordered eating. A sample of N = 226 female undergraduate students in the U.S. completed an online survey assessing the variables of interest. After minor modification to the model pathways, the model provided a good fit to the data. Sociocultural influences to pursue thinness and fear fat related to body dissatisfaction and disordered eating through internalization of the thin-ideal and fear of fat. Together, these findings suggest that the pursuit of thinness and fear of fatness are distinct elements in etiologic models of body dissatisfaction and disordered eating. Additional work, including longitudinal research and studies among more diverse groups of individuals, is warranted to further clarify these relationships.

Body image concerns and disordered eating among older women: Identifying variables of interest for integrated models

OBJECTIVE

Research focused on developing risk and protective models of body image concerns and disordered eating among older women is scant. Models including biological, psychological, and sociocultural elements may be useful explanatory frameworks in this group. Thus, the aim of this study was to conduct formative research exploring the constructs that form part of biopsychosocial models of body image concerns and disordered eating among older women.

METHOD

A sample of 184 women aged 60-75 years completed an online survey assessing media pressures, thin-ideal internalization, depression symptoms, weight and shape concerns, and disordered eating as well as positive reappraisal and acceptance of aging-related changes to appearance.

RESULTS

After the addition of two supplemental pathways, the model revealed good fit to the data. In the final model, age, depression, and media pressure were associated with media internalization, that was in turn associated with weight and shape concerns, and then disordered eating. Depression was also directly associated with both weight and shape concerns and disordered eating. The model varied across older women with high versus low levels of positive reappraisal and acceptance of aging-related changes to appearance. Specifically, among those high on this trait, the pathways between depression and thin-ideal internalization, and between weight and shape concerns and disordered eating were significantly weaker.

DISCUSSION

These findings support the usefulness of biopsychosocial models for grounding research on body image concerns and disordered eating among older women, and suggest positive reappraisal and acceptance of aging-related changes to appearance as a useful dimension to focus on.

Pathways from sociocultural and objectification constructs to body satisfaction among women: The U.S. Body Project I

Objectification theory proposes that widespread sexualization causes women to engage in surveillance of their appearance. We integrated this concept into a model with constructs from the tripartite influence model, which proposes that body dissatisfaction is a result of internalizing cultural notions of thin ideal beauty that stem from family, peer, and media appearance-related pressures. We tested this model with an online sample of 6327 adult women. Specifically, we tested whether these pressures predicted increased thin-ideal and muscular-ideal internalization, leading to greater body surveillance, and in turn lower appearance evaluation and body image quality of life. Structural equation modeling supported many aspects of the model. Family, peer, and media pressures related to higher thin-ideal internalization, which related to higher body surveillance and lower appearance evaluation. Peer and media pressures related to higher muscular-ideal internalization, which related to lower appearance evaluation. However, muscular-ideal internalization was not related to body image quality of life. An indirect relationship emerged between thin-ideal internalization and body image outcomes via body surveillance. Body mass index (BMI) moderated several of these model paths. Findings highlight the value of this integrated sociocultural model, and of BMI as an important moderating factor when examining objectification and tripartite influence models.

Sexual orientation differences in pathways from sociocultural and objectification constructs to body satisfaction: The U.S. Body Project I

Objectification theory and the tripartite influence model provide useful frameworks for understanding the body image experiences of men and women. However, there is little systematic investigation of how sexual orientation moderates the links between these constructs and body image satisfaction. It has been hypothesized, for example, that the associations of surveillance (i.e., monitoring of one's appearance due to objectification by others) would be strongest for groups targeted by the male gaze (e.g., gay men, lesbian women, and bisexual men and women). Here we proposed an integrated sociocultural model and examined these pathways in multigroup structural equation models in a national sample of heterosexual, bisexual, and lesbian women (ns = 5395; 598; 213, respectively), and heterosexual, bisexual, and gay men (4869; 194; and 194, respectively) aged 18-65 years. Sexual orientation moderated some of these pathways. The most consistent pattern was that appearance pressures were internalized to a greater extent among bisexual participants. The pathways to poorer body image were generally similar among heterosexual and gay/lesbian men and women. These findings highlight the importance of examining sexual orientation-specific influences on body image across diverse groups, as well as the commonalities in the experiences of men and women across sexual orientations.

Testing of a model for risk factors for eating disorders and higher weight among emerging adults: Baseline evaluation

Although a range of risk factors have been identified for disordered eating and weight status, the breadth of risk factors have been rarely considered within a single, comprehensive model. The robustness of these findings across countries also remains an open question. The present study sampled 6272 participants aged 18-30 years from eight countries in an attempt to evaluate combined and unique predictors for these two conditions, and to explore possible cross-country differences in these models. Participants completed a range of demographic, biological, behavioral, psychological, and sociocultural measures to test a comprehensive model of the contributions of these predictors for disordered eating and weight-related constructs (binge eating, body mass index, compensatory behaviors, dietary restraint, drive for muscularity, and drive for leanness). Structural invariance testing within a multigroup path analysis framework revealed that a single model across the eight countries provided poor model fit. Freeing of 22% of parameters across countries provided excellent fit and a satisfactory compromise for country-invariant and country-variant parameters in the model. Overall, predictors accounted for between 15% and 60% of variance in the outcome measures, with lowest explained variance for the disordered eating outcomes. Significant unique contributions to prediction were observed for each of the five risk factor variable types and across the eight countries. Thus, the findings show strong support for this model as an explanatory framework of both disordered eating and weight status.

Psychometric validation of the Japanese version of the Functionality Appreciation Scale (FAS)

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) is a widely adopted measure to assess appreciation for one's body and its capacity. In this study, we performed a psychometric validation of the Japanese translation of the FAS. Participants included an online sample of 750 Japanese individuals (20-70 years old), who completed the FAS and other previously validated measures of body appreciation, intuitive eating, gratitude, self-esteem, and life satisfaction. Moreover, the survey was conducted twice, 3 weeks apart, to determine test-retest reliability. Exploratory factor analyses replicated the unidimensional factor structure of the FAS, which was also verified by the confirmatory factor analysis. FAS scores had gender invariance, and demonstrated good internal consistency and test-retest reliability over the 3-week period. In addition, further analyzes indicated adequate construct, and incremental validity. These findings indicate that the Japanese version of FAS demonstrates good psychometric properties, and can be used to examine the importance of functionality appreciation for enhancing positive body image and healthy eating.

Socio-cultural beliefs about an ideal body size and implications for risk of excess weight gain after immigration: a study of Australian residents of sub-Saharan African ancestry

Objectives: Though several studies have focused on risk factors associated with excess weight gain, little is known about the extent to which socio-cultural beliefs about body sizes may contribute to risk of excess weight gain, especially in non-Western migrant communities. Drawing on socio-cultural and attribution theories, this study mainly explored socio-cultural beliefs about an ideal body size among Australian residents who were born in sub-Saharan Africa (SSA).  Implications of body size beliefs for risk of excess weight gain after immigration have also been discussed.Design: Employing a qualitative design, 24 in-depth interviews were conducted with Australian residents who were born in SSA. Thematic content analysis was undertaken to ensure that participants' experiences and views were clearly captured.Results: According to the participants, a moderately large body size is idealised in the SSA community and post-migration weight gain is commonly regarded as evidence of well-being. While desirability of a moderately large body size was noted by some participants, others were concerned about health risks (e.g. high blood pressure) associated with excess weight gain. Moreover, body size ideals seemed to be different for men and women in the SSA community and these ideals were mainly promoted by family and friends. Participants reported that women with very slim (skinny) body sizes are often regarded as persons suffering from health problems, whereas those with 'plumpy' body types are often considered beautiful. Participants also noted that men are expected to look well-built and muscular while those with big bellies are often seen as financially rich.Conclusions: Participants' interpretation of post-migration weight gain as evidence of well-being calls for urgent intervention as risk of excess weight gain appear to be high in this immigrant group.

Beauty ideals, social media, and body positivity: A qualitative investigation of influences on body image among young women in Japan

Body image and eating concerns are prevalent among Japanese young women and result in part from exposure to unrealistic media imagery. In Western contexts, a growing body of research has explored the impact of social media on body image and eating disorder risk, and the potential for body positive media to mitigate these harmful effects. However, similar research in Japan is lacking. The aim of the present study was to qualitatively explore media and social media influences on body image and associated behaviors among young women in Japan, with a specific focus on body positive media content. Female university students in Japan (n = 29) participated in majority group and some individual interviews. Thematic analysis revealed four primary themes: (1) media appearance pressures: additive pressures of Japanese and Western ideals through globalization, (2) criticism of, resistance to, and negotiating appearance ideals, and (3) presence of body positivity in Japan, and (4) media as a background for interpersonal appearance pressures. High pressure towards thinness emerged, perceived as contributing to weight control behaviors that were calibrated to avoid being "unhealthy." Desire for greater body diversity in Japanese media emerged; however, findings suggest body positive messaging is scarce and mainly limited to high-profile celebrities.

Does the tripartite influence model of body image and eating pathology function similarly across racial/ethnic groups of White, Black, Latina, and Asian women?

The tripartite influence model suggests that appearance pressures from family, peers, and the media contribute to thin-ideal internalization, which leads to increased body dissatisfaction and subsequent eating disorder pathology. The tripartite influence model was initially developed and tested among primarily White samples, and emerging research suggests racial/ethnic differences in mean levels of particular model constructs. Consequently, the model's appropriateness for understanding eating disorder risk in racial/ethnic minorities warrants investigation to determine its usefulness in explicating eating disorder risk in diverse populations. Participants in the current study were White (n = 1167), Black (n = 212), Latina (n = 203), and Asian (n = 176) women from five geographically disparate college campuses in the United States. Participants completed the Sociocultural Attitudes Towards Appearance Questionnaire-4, the Multidimensional Body-Self Relations Questionnaire - Appearance Evaluation Subscale, and the Eating Disorder Examination-Questionnaire. Analysis of variance was used to compare mean levels of each construct across racial/ethnic groups. Multigroup structural equation modeling was used to assess the appropriateness of the tripartite influence model for each racial/ethnic group, and to examine differences in the strength of the model pathways across groups. There were significant mean level differences across groups for most model constructs. However, results indicated similar model fit across racial/ethnic groups, with few differences in the strength of model pathways. Findings suggest that although some groups report lower levels of proposed risk factors, the sociocultural risk processes for eating pathology identified through the tripartite influence model are similar across racial/ethnic groups of young adult women. Such information can be used to inform culturally-sensitive interventions.

An exploration of the tripartite influence model of body image in Lithuanian sample of young adults: does body weight make a difference?

PURPOSE

The present study aimed to test the sociocultural Tripartite Influence Model (TIM) that helps to explain the associations between the sociocultural pressures to achieve stereotyped body ideals and disordered eating in young Lithuanian women and men of different body mass.

METHODS

A mixed-gender sample of students (n = 1850, 58.8% female, the mean age of men was 20.4 (SD = 3.1) years, of women 22.4 (SD = 5.8) years) filled in series of questionnaires including the social attitudes towards appearance, body image, disordered eating and drive for muscularity. Mediation analyses were performed to estimate the size of total, direct, and indirect effects of variables in the models.

RESULTS

For women of different body weight, the TIM model was fully replicated. For men of normal weight, internalization of the muscular/athletic ideal, drive for muscularity and greater investment towards appearance mediated the relationships between peers' pressures and disordered eating. For overweight men, internalization of the thin and muscular/athletic ideals, poorer body image mediated associations between pressure from the peers and disordered eating. However, the internalization of the muscular/athletic ideal and the greater appearance evaluation mediated the associations between sociocultural pressures and disordered eating for overweight and obese men.

CONCLUSION

The TIM was replicated in women of different body weight. However, internalization of the thin/low fat ideal was not relevant for men of normal body weight and internalization of the muscular ideal had different outcomes for men of different body mass index. The implications of the results for practice are discussed.

LEVEL OF EVIDENCE

V, Cross-sectional descriptive study.

Real beauty: Effects of a body-positive video on body image and capacity to mitigate exposure to social media images

OBJECTIVE

Recent industry-created social marketing campaigns have targeted positive body image; however, research investigating the effects of such social media campaigns on body image has largely neglected non-Western English-speaking groups. This study explored the effects on body image of a video produced by Dove for a Japanese audience 'Real Beauty ID', and its capacity to modify the effects of subsequent exposure to celebrity social media images of young women.

METHOD

Young women from Japan (n = 568), mean age (SD) = 25.38 (3.52) years, were randomly allocated to view either the Dove Real Beauty ID video, or a control video, followed by exposure to celebrity social media images (female celebrities or landscapes). Finally, participants reported on state and trait appearance-based comparisons, thin ideal internalization, body appreciation, and media similarity scepticism.

RESULTS

Among participants with high levels of thin ideal internalization, those who viewed the Dove Real Beauty ID video reported significantly lower satisfaction with body and facial features, as well as more negative mood (p < .05) compared with the control video. Little support emerged for the capacity of the Dove Real Beauty ID video to modify the effects of exposure to celebrity social media images, nor were these effects moderated by risk and resilience factors.

CONCLUSIONS

In sum, no usefulness emerged for the Dove Real Beauty ID video in promoting positive body image, and limited usefulness was seen in buffering the effects of exposure to celebrity social media images among Japanese young women. Given the reach of such interventions, exploring whether interventions that are culturally adapted and theoretically driven are more helpful is warranted.

Exploring the gratitude model of body appreciation and intuitive eating among Japanese women

Culture is believed to play a central role in body image and eating problems, and for this reason, it is important to conduct cross-cultural investigations of relevant theoretical models. This study involves a non-Western replication of one of the few existing models of positive body image, the gratitude model of body appreciation, which was originally developed using American women. The model postulates that a grateful attitude is associated with body appreciation and intuitive eating via reduced contingent self-worth and social comparison. The current study aims to examine the applicability of the model to Japanese women. A sample of 648 Japanese women (age range = 15-69, M = 42.1, SD = 15.7) completed online measures of gratitude, contingent self-worth, social comparison, body appreciation, and intuitive eating. In general, all paths in the original model were replicated in the current model. However, two new paths were added to achieve good fit, including a path from basing one's self-worth on others' approval to body appreciation and another path from gratitude directly to intuitive eating. These differential pathways are discussed in the context of Japanese culture that emphasizes appreciation towards foods and self-definition based on social approval. In addition, implications for intervention are described.

Psychometric properties of measures of sociocultural influence and internalization of appearance ideals across eight countries

The aim of the current study was to examine the psychometric properties of two well-established measures of sociocultural influence and internalization of the thin/low body fat ideal and muscular ideal. Data from 6272 emerging adults (68.9 % female), aged 18-30 years from Australia, Belgium, Canada, China, Italy, Japan, Spain, and the U.S. were included in this study. Participants completed measures of pressure from mother, fathers, peers, and media, to both increase muscles and lose weight, as well as internalization of the thin/low body fat ideal and muscular ideal. Overall, support for partial invariance was found across the scales. In addition, group level differences were found between countries as well as along demographic factors including gender, age, body mass index, and socioeconomic status. These findings make an important contribution by identifying these scales as useful tools that will support future cross-country and cross-cultural examinations of explanatory models of the development of body image and eating concerns grounded within sociocultural theories.

The effects of fitspiration images on body attributes, mood and eating behaviors: An experimental Ecological Momentary Assessment study in females

Through an experimental Ecological Momentary Assessment (EMA) design, we assessed the effects of fitspiration images (relative to neutral) on body image, mood and disordered eating and whether trait body dissatisfaction, thin-ideal internalization and pressures from the media, family and peers moderated these effects. After completing trait-based measures, 85 women were prompted via a mobile application 6 times daily for 7 days to view an image (fitspiration or neutral) and report on state levels of perceived pressures to attain an idealized physique, satisfaction with various body attributes, mood and eating behavior. When participants were exposed to fitspiration images, their perceived pressure to attain an idealized physique was significantly higher than after exposure to the control images. This effect was most pronounced for women experiencing pressure from the media. Furthermore, fitspiration images lowered the extent to which women felt that idealized physiques were attainable, and decreased satisfaction with current fitness. There were no significant effects on mood and disordered eating. Exposure to fitspiration content predicted only a few adverse outcomes in terms of negative body attributes and perceived pressures to attain a similar physique, suggesting that its content is not as detrimental as initially believed, but further research is needed.

An application of psychosocial frameworks for eating disorder risk during the postpartum period: A review and future directions

The postpartum period may be a particular window of vulnerability for eating disorder symptoms given changes to body shape and weight that women experience. However, no quantitative studies have identified risk factors for postpartum eating disorder symptoms, and current psychosocial frameworks of risk may be missing key elements unique to this period. This manuscript reviews existing quantitative and qualitative literature regarding the developmental trajectory of eating disorder symptoms during the perinatal period and proposes an application of three psychosocial models of eating disorder risk (objectification theory, the tripartite influence model of body image and eating disturbances, and social comparison theory) to the postpartum period. Drawing on quantitative and qualitative literature, this paper identifies novel postpartum-specific factors that should be included for consideration in psychosocial models (e.g., self-oriented body comparison and pressure to achieve a prepregnancy weight and shape). This review is the first to theorize potential postpartum-specific risk factors for postpartum eating disorder symptoms. Prior models of eating disorder risk omit key psychosocial factors that are unique to the postpartum period. Other limitations of prior research relate to measurement and methodology. This critical window of vulnerability has been largely ignored in the quantitative literature and necessitates further research.

Body image and disordered eating in older women: A Tripartite Sociocultural model

Evidence suggests that body image concerns and disordered eating exist in women even at older ages. Few studies have examined the factors that are related with body image and eating concerns in this age group. In particular, the roles of sociocultural influences and thin-ideal internalization remain unclear. In the present study, we tested a modified tripartite sociocultural model of body image and disordered eating behaviors in a sample of 222 women aged 60 to 75 years, using structural equation modeling. After adjustment, a model similar to that observed in young women was a good fit to the data. Perceived pressure from the media revealed a direct relationship with body image concerns, as well as an indirect relationship mediated by thin-ideal internalization. Peer pressure was directly associated with body image concerns, and thin-ideal internalization was associated with dieting. In older women, pressure to conform to appearance ideals, in particular from the media, may impact the internalization of appearance ideals and body image concerns that might, in turn, increase disordered eating. The usefulness of sociocultural models for framing body image and eating concerns in older women implies that similar prevention interventions to those used in younger women could be adapted to fill a gap in available resources for this group.

Sociocultural Influences, Drive for Thinness, Drive for Muscularity, and Body Dissatisfaction among Korean Undergraduates

For many years, body dissatisfaction was considered a western phenomenon, and was studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This research investigated the differential effects of various sociocultural pressures transmitted from the media, one’s parents, and one’s peers on the drives for thinness and muscularity, and body dissatisfaction among 1125 Korean college students (56% male) using structural equation modeling. The results indicate that, after controlling for body mass index and exercise, media pressures exerted the largest effects on participants’ body ideals and, in turn, body dissatisfaction across both genders (β = 0.44, and 0.30, p < 0.05, for females and males, respectively). This study’s results also indicate that there are considerable gender differences in this relationship. Specifically, the results show that parental and media pressure had significant indirect relationships with body dissatisfaction via the drive for thinness among females, while peer and media pressures had significant indirect relationships with body dissatisfaction via the drive for muscularity among males. As body dissatisfaction is known to significantly affect an individual’s mental and physical health, future research needs to identify relevant influential factors in this area, as well as the paths they have leading to increased body dissatisfaction.

Body Image and Sociocultural Predictors of Body Image Dissatisfaction in Croatian and Chinese Women

In the current paper, two different studies were designed to investigate body image dissatisfaction and perception of the attractive female body in Chinese and Croatian women and men using the correlational and experimental study research approach. Study 1 comprised 266 Chinese (160 women; 106 men) and 261 Croatian participants (161 women; 100 men). Women from both countries were asked to complete the measures of the Contour Rating Scale, SATAQ - 4, Body Area Scale and demographic data, while men were asked to complete the measures of the Contour Rating Scale and demographic data via online surveys. The obtained results indicated that thin internalization predicted body image dissatisfaction in both samples. Besides, while both samples scored relatively high on thin-ideal internalization, Chinese women, who were also in general less satisfied with their body image, had higher scores. Chinese women also scored higher on musculature internalization and felt more pressure from family, friends, and media to conform to standard beauty norms compared to Croatian women. The samples also differed in their perceptions of preferable body size, where Chinese women had a more negative perception of their actual body size. The obtained results furthermore revealed that Chinese men preferred thinner women compared to Croatian men. Moreover, both samples misjudged what their female counterparts found attractive, thinking that women wanted to have even thinner bodies than they actually reported. Similarly, women from both cultures revealed a preference for thinner figures than the ones selected as the most attractive by the opposite sex. Finally, in Study 2, experimental manipulation of thin-ideal was used to examine whether thin priming affected body image dissatisfaction. The obtained results revealed that when primed with thin-ideal women from both countries felt lower satisfaction with their body size. The observed effect was stronger for Chinese participants. Limitations of the current study are discussed in the conclusion.

Body Image in the Context of Eating Disorders

Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.

Prospective relations among internalization of beauty ideals, body image concerns, and body change behaviors: Considering thinness and muscularity

Common models propose that the internalization of societal beauty ideals influences disordered eating behaviors and muscularity-oriented behaviors via body image concerns. However, previous studies addressing these pathways have been mainly cross-sectional and primarily included female samples. We investigated these pathways prospectively in male and female adolescents and young adults, examining two pathways: a 'weight/shape pathway,' linking thin-ideal internalization, weight/shape concern, and restrained eating, and a 'muscularity pathway,' linking athletic-ideal internalization, muscularity concern, and muscularity-oriented behavior. Across three time points, 973 participants from the German general population were assessed. Although the hypothesized pathways could not be supported in their complete temporal sequence, several hypothesized pathways occurred across two time points. Among others, weight/shape concern predicted restrained eating and the athletic ideal played a prominent role in the prediction of muscularity-oriented behavior in both genders.

Prospective predictors of body dissatisfaction, drive for thinness, and muscularity concerns among young women in France: A sociocultural model

The aim of this study was to explore a prospective sociocultural model of the influence of media, peers, and partners on body dissatisfaction, drive for thinness, and muscularity concerns in a sample of young women in France. A sample of 192 undergraduate women with a mean age of 20.97 years (SD = 2.69) completed a questionnaire at two time-points, 12 months apart, assessing media and interpersonal influences, appearance comparison, body dissatisfaction, drive for thinness, and muscularity concerns. The final model highlighted that media and interpersonal influences (from peers and romantic partners) were associated over time with increased body dissatisfaction, drive for thinness, and muscularity concerns one year later, via appearance comparison. Sociocultural influences towards both thinness and muscularity may contribute to increases in body image concerns and risky body change behaviors in young women in France.

Exploring the Tripartite Influence Model of body dissatisfaction in postpartum women

Pregnancy and childbirth result in dramatic changes in a woman's body shape, which can be associated with body image concerns. To date, however, little is known about how sociocultural factors may influence body dissatisfaction in postpartum women. This study aimed to test a sociocultural model of body image and eating concerns among a sample of postpartum women. A sample of N=474 women, mean (SD) age=30.6 (4.8), having given birth during the last year, completed an online survey and reported on sociocultural pressures from media, peers, family and partners, thin-ideal internalization, appearance comparison, body dissatisfaction, and psychological functioning. Structural equation modeling analyses revealed a good fit to the data, χ² (49)=220.20, p<.001, RMSEA=.086, CFI=.93. Findings suggest that women experience strong sociocultural pressures to attain unrealistic body shapes/sizes during the post-pregnancy period, contributing to their body image concerns.

Eating behaviour disorders among adolescents in a middle school in Dongfanghong, China

BACKGROUND

Disordered eating behaviours (DEB) are significant public health challenges among adolescents. DEB are prevalent among Chinese young people and replication epidemiological studies in DEB are needed due to ongoing rapid modernization and socio-economic change. In addition, there has been no prevention or intervention programs for DEB in most of rural areas in China and research in DEB in rural China is limited. More research in DEB in rural China is needed for increased awareness of prevention strategies. The objectives of the study are to examine the prevalence and associated factors of DEB among rural Chinese adolescents.

METHODS

Four hundred and sixty-six students aged 11-18 years old from a middle school in rural China were invited to complete a self-reported questionnaire that included measures on DEB and psychosocial factors. The SCOFF questionnaire was applied to measure DEB (i.e., a score of > = 2 indicates a likely case of DEB). Logistic regression models were applied for data analyses. A p-value <0.05 was regarded as statistically significant.

RESULTS

There were 389 adolescents (11-18 years) included in this study with the prevalence of DEB being 28.8%. No significant differences were found between male adolescents (30.5%) and female adolescents (27.1%). Independently, perceived overweight (OR = 2.80, 95% CI = 1.05-7.48), negative affect (OR = 1.07, 95% CI = 1.03-1.12), body dissatisfaction (OR = 0.96, 95% CI = 0.93-0.99), and watching TV (OR = 2.40, 95% CI = 1.11-5.18) were significantly (p < 0.05) associated with DEB.

CONCLUSION

This study indicates a high prevalence rate of DEB among rural adolescents and associated factors of DEB from a school-based sample. Such findings imply that local public health systems should pay more attention to DEB and design prevention and intervention strategies for DEB.

An etiological model of disordered eating behaviors among Brazilian women

The Tripartite Influence Model posits that parents, peers and media influences mediated by internalization and appearance social comparison are predictors of body dissatisfaction, a key risk factor for eating disorders. However, the Tripartite Influence Model has not been tested in Brazil where the people are known to have high levels of body image and appearance concerns. This study aimed to test an adapted Tripartite Influence Model of body dissatisfaction and disordered eating behaviors among Brazilian women. A sample of 741 undergraduate students (M_age = 23.55 years, SD = 4.09) completed measures of sociocultural influences, internalization of body ideal, social appearance comparison, body dissatisfaction, muscularity dissatisfaction, disordered eating and body change behaviors. Structural equation modeling analyses indicated that the proposed etiological model for Brazilian women has good fit indexes (χ²(2064) = 6793.232; p = 0.0001; χ²/gl = 3.29; CFI = 0.82; PCFI = 0.79; RMSEA = 0.056 [IC90% = 0.053-0.057]). Parent and media influences were related with both internalization and social comparison, while peer influence with social comparison. A full mediation model was found, with both internalization and social comparison contributing to body dissatisfaction. Finally, body dissatisfaction was associated with disordered eating behaviors. The findings inform the importance of considering cultural aspects that influence body image and eating behaviors, and highlight the validity of the proposed etiological model for Brazilian women, that can be used for research and clinical purposes.

Internalization of appearance ideals mediates the relationship between appearance-related pressures from peers and emotional eating among adolescent boys and girls

Appearance-related pressures have been associated with binge eating in previous studies. Yet, it is unclear if these pressures are associated with emotional eating or if specific sources of pressure are differentially associated with emotional eating. We studied the associations between multiple sources of appearance-related pressures, including pressure to be thin and pressure to increase muscularity, and emotional eating in 300 adolescents (M_age=15.3, SD=1.4, 60% female). Controlling for age, race, puberty, body mass index (BMI) z-score, and sex, both pressure to be thin and pressure to be more muscular from same-sex peers were positively associated with emotional eating in response to feeling angry/frustrated and unsettled (ps<0.05). Pressure from same-sex peers to be more muscular also was associated with eating when depressed (p<0.05), and muscularity pressure from opposite-sex peers related to eating in response to anger/frustration (p<0.05). All associations were fully mediated by internalization of appearance ideals according to Western cultural standards (ps<0.001). Associations of pressures from mothers and fathers with emotional eating were non-significant. Results considering sex as a moderator of the associations between appearance-related pressures and emotional eating were non-significant. Findings illustrate that both pressure to be thin and muscular from peers are related to more frequent emotional eating among both boys and girls, and these associations are explained through internalization of appearance-related ideals.

Psychometric properties and validation of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) with a sample of Japanese adolescent girls

The Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) is a 22-item five-factor measure that assesses thin- and muscular-ideal internalization as well as appearance-related pressures from peers, family, and media. The scale has been validated in Western cultures, but has not yet been examined in Eastern samples. Two studies were conducted to examine the psychometric properties of the SATAQ-4 among 946 Japanese adolescent girls. In Study 1, exploratory factor analysis of the SATAQ-4 indicated that the five-factor structure was largely replicated with the exception of two cross-loading items. In Study 2, confirmatory factor analysis indicated good fit for the full 22-item and reduced 20-item versions of the measure. SATAQ-4 subscales exhibited good internal consistency and were correlated in the expected direction with experiences of appearance teasing, strategies to lose and/or gain weight, and drive for muscularity. Overall, results support the reliability and validity of the SATAQ-4 among Japanese adolescent girls.

Fat Talk and Body Image Disturbance

Although the link between fat talk and body dissatisfaction is well established, the link between fat talk and other body image disturbance components remains underexplored. Our meta-analytic review explored the cross-sectional, experimental, and longitudinal relations between fat talk and body dissatisfaction, body surveillance, body shame, pressure to be thin, thin-ideal internalization, body checking, and appearance-based comparisons. We identified 35 relevant studies via electronic databases. Meta-analyses provided effect size estimates based on study design and whether fat talk was the predictor or outcome of body image disturbance. Results showed that fat talk is related to a broader range of body image constructs than just body dissatisfaction and that accumulated evidence from longitudinal and experimental studies—although limited in number—suggests it is more plausible that fat talk is a risk factor for these body image constructs, rather than a consequence of them. Nevertheless, the suggestion that fat talk may play a role in the causal sequence of body image issues highlights this as a potential area of intervention for researchers and clinicians. Given that fat talk is common and often well intentioned, awareness-raising exercises for parents and peers may be necessary to curb its incidence and impacts. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index .

Associations between Chinese/Asian versus Western mass media influences and body image disturbances of young Chinese women

In this study, we evaluated associations of experiences with mass media imported from Western nations such as the United States versus mass media from China and other Asian countries with eating and body image disturbances of young Chinese women. Participating women (N=456) completed self-report measures of disordered eating, specific sources of appearance dissatisfaction (fatness, facial features, stature), and Western versus Chinese/Asian mass media influences. The sample was significantly more likely to report perceived pressure from, comparisons with, and preferences for physical appearance depictions in Chinese/Asian mass media than Western media. Chinese/Asian media influences also combined for more unique variance in prediction models for all disturbances except stature concerns. While experiences with Western media were related to disturbances as well, the overall impact of Chinese/Asian media influences was more prominent.

Sociocultural pressure, internalization, BMI, exercise, and body dissatisfaction in Korean female college students

This research investigated the differential effects of sociocultural pressures from media, peers, and parents on the thin ideal internalization and body dissatisfaction of 472 Korean female college students using structural equation modeling. Results indicated that after controlling for body mass index and exercise, media pressure exerted the largest effects, followed by peer pressure and parental pressure, on thin ideal internalization, and in turn, body dissatisfaction. Furthermore, parent and media pressures were found to exert direct effects on body dissatisfaction as well as indirect effects through thin ideal internalization. The results and implications of the study are discussed.

A test of athletic internalisation as a mediator in the relationship between sociocultural influences and body dissatisfaction in women

The tripartite model has been an important and empirically supported theoretical model positing that the influence of peers, family, and media leads women to internalise the thin societal body ideal. This internalisation in turn leads women to experience body dissatisfaction. Recently, a new societal 'athletic ideal' for women has emerged, which promotes a body frame with pronounced lean muscle mass. This study tested the role of the athletic ideal in the tripartite model of influence with a sample of 421 women aged 17-40 years. Athletic ideal internalisation was neither found to be associated with body dissatisfaction, nor act as a mediator in the relationship between sociocultural influences and body dissatisfaction. Although more research is required, the results of this study suggest that for this cross-sectional sample of women, internalisation of an athletic and muscular, rather than thin ideal, may be less detrimental to body satisfaction.

A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?

Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.

The effects of advertisements that sexually objectify women on state body dissatisfaction and judgments of women: The moderating roles of gender and internalization

Experimental studies have demonstrated that exposure to idealized images of women increases state body image disturbance. However, little work has experimentally examined the effects of exposure to images that sexually objectify women, especially as it relates to women and men's state body dissatisfaction and judgments of women. In the current study, 437 women and men were randomly assigned to view advertisements that sexually objectify women and portray appearance ideals, or to view non-appearance-related advertisements. Results indicated that state body dissatisfaction increased for women and men exposed to advertisements that sexually objectified women, although this effect was larger for women. Trait internalization of appearance ideals moderated this effect, indicating that women and men with higher internalization exhibited greater state body dissatisfaction after viewing women sexually objectified in advertisements. Exposure to women sexually objectified in advertisements did not affect women's or men's attractiveness or competence ratings of women in university advertisements.

Is cultural change associated with eating disorders? A systematic review of the literature

BACKGROUND

There is debate as to whether the development of an eating disorder (ED) may be triggered by acculturation to Western culture. While there is evidence to suggest that acculturation to Western culture is associated with risk of having an ED, these findings are limited, vary significantly, and are sometimes conflicting.

AIMS

To review the literature and empirical data on the association between ED symptoms and acculturation in the context of Western culture.

METHODS

A systematic search of peer-reviewed publications using a combination of the keywords "Culture", "Acculturation" and "Eating disorders" was first performed in August 2014 and updated in February 2015 with the following databases: PubMed and SCOPUS. Reference lists were also hand searched. In total, the search provided more than 50 studies. Following screening (as stated in the PRISMA guidelines) of the titles and abstracts by inclusion and exclusion criteria and quality assessment of the full text, 25 studies were identified to be appropriate for the review. Articles were examined in relation to the findings, as well as the ED and acculturation measures used.

RESULTS

Eleven studies suggested considerable association between ED and culture change/acculturation. Six studies suggested little or no association between ED and culture change/acculturation. Eight studies did not primarily examine association, yet generated valuable insight. While there was relative consistency across studies in terms of the ED measures selected, measures of acculturation varied significantly.

CONCLUSIONS

The majority of the evidence reviewed here suggests that there is a substantial association between culture change and ED psychopathology. However, both greater and lesser acculturation have been identified as risk factors for the development of an ED, and this varies depending on the group studied as well as how acculturation and culture change are conceptualized and measured. Further research is warranted to form cross-culturally acceptable definitions and measures of problematic eating, and healthy and high acculturation, to study the relationship between EDs and the process of acculturation to Western culture.

Unnecessary Dieting Intention and Behavior among Female Students in Naha City, Japan

Weight concerns and dieting are prevalent among female adolescents both in Western and Asian countries. They can result in negative psychological and physiological consequences. This study aimed to examine the relative importance of social and personal factors in the decision to diet among female adolescent students in Japan, applying the Theory of Planned Behavior. Data were collected from five junior high schools and three high schools in Naha City, Okinawa Prefecture, in 2010, through self-administered questionnaires. The data of 756 female students were assessed. The independent variables included social factor variables (norms) and personal factor variables (attitude to dieting, perceived behavior control, body esteem, body-figure discrepancy and past dieting). The dependent variables were dieting intention and behavior. Hierarchical multiple regression analyses were performed to examine three models: model 1 (age and obesity index), model 2 (social factor variables with age and obesity index) and model 3 (all variables). Although model 2 failed to explain a substantial proportion of the variance, model 3 explained approximately a half of the variance for intention (R² = 0.507) and more than one third of the variance for behavior (R² = 0.376). Past experience of dieting was the best predictor of both dieting intention and behavior. Body esteem was the second best predictor for dieting behavior. In conclusion, personal factors are more likely than social factors to drive the dieting decision. Diet education programs should consider targeting frequent dieters and those with poor body esteem.

Cross-cultural examination of beliefs about the causes of bulimia nervosa among Australian and Japanese females

OBJECTIVE

To identify similarities and differences in beliefs about the causes of Bulimia Nervosa (BN) held by Asian (Japanese) women and Western (Australian) women, and hence, to examine the applicability of belief models of eating disorders (ED) across different cultures.

METHOD

Four hundred three Japanese and 256 Australian female university students (aged 17-35 years) completed a questionnaire that gauged beliefs about the causes of BN.

RESULTS

Among the Australian women, the four-component structure of perceived causes (dieting and eating practices, family dynamics, socio-cultural pressure, and psychological vulnerability) found in Dryer et al. (2012) was replicated. Among the Japanese women, however, a three-component structure (without the psychological vulnerability component) was obtained. The groups also differed in the causal component they most strongly endorsed, that being socio-cultural pressure for the Australian women, and dieting and eating practices for the Japanese women.

DISCUSSION

The Japanese participants were found to endorse three out of the four Western-based causal explanations for BN, but the relative importance they placed on those explanations differed from that of the Australian participants. Further research is needed, particularly to establish whether Japanese women simply fail to see psychological vulnerability as a viable cause of BN, or there are in fact cultural differences in the extent to which such vulnerability causes BN.

Globalization and eating disorder risk: peer influence, perceived social norms, and adolescent disordered eating in Fiji

OBJECTIVE

The increasing global health burden imposed by eating disorders warrants close examination of social exposures associated with globalization that potentially elevate risk during the critical developmental period of adolescence in low- and middle-income countries (LMICs). The study aim was to investigate the association of peer influence and perceived social norms with adolescent eating pathology in Fiji, a LMIC undergoing rapid social change.

METHOD

We measured peer influence on eating concerns (with the Inventory of Peer Influence on Eating Concerns; IPIEC), perceived peer norms associated with disordered eating and body concerns, perceived community cultural norms, and individual cultural orientations in a representative sample of school-going ethnic Fijian adolescent girls (n = 523). We then developed a multivariable linear regression model to examine their relation to eating pathology (measured by the Eating Disorder Examination-Questionnaire; EDE-Q).

RESULTS

We found independent and statistically significant associations between both IPIEC scores and our proxy for perceived social norms specific to disordered eating (both p < .001) and EDE-Q global scores in a fully adjusted linear regression model.

DISCUSSION

Study findings support the possibility that peer influence as well as perceived social norms relevant to disordered eating may elevate risk for disordered eating in Fiji, during the critical developmental period of adolescence. Replication and extension of these research findings in other populations undergoing rapid social transition--and where globalization is also influencing local social norms--may enrich etiologic models and inform strategies to mitigate risk.

Genetic and environmental influences on thin-ideal internalization across puberty and preadolescent, adolescent, and young adult development

OBJECTIVE

Mean-levels of thin-ideal internalization increase during adolescence and pubertal development, but it is unknown whether these phenotypic changes correspond to developmental changes in etiological (i.e., genetic and environmental) risk. Given the limited knowledge on risk for thin-ideal internalization, research is needed to guide the identification of specific types of risk factors during critical developmental periods. The present twin study examined genetic and environmental influences on thin-ideal internalization across adolescent and pubertal development.

METHOD

Participants were 1,064 female twins (ages 8-25 years) from the Michigan State University Twin Registry. Thin-ideal internalization and pubertal development were assessed using self-report questionnaires. Twin moderation models were used to examine if age and/or pubertal development moderate genetic and environmental influences on thin-ideal internalization.

RESULTS

Phenotypic analyses indicated significant increases in thin-ideal internalization across age and pubertal development. Twin models suggested no significant differences in etiologic effects across development. Nonshared environmental influences were most important in the etiology of thin-ideal internalization, with genetic, shared environmental, and nonshared environmental accounting for approximately 8%, 15%, and 72%, respectively, of the total variance.

DISCUSSION

Despite mean-level increases in thin-ideal internalization across development, the relative influence of genetic versus environmental risk did not differ significantly across age or pubertal groups. The majority of variance in thin-ideal internalization was accounted for by environmental factors, suggesting that mean-level increases in thin-ideal internalization may reflect increases in the magnitude/strength of environmental risk across this period. Replication is needed, particularly with longitudinal designs that assess thin-ideal internalization across key developmental phases.