Internalization of muscularity and thinness ideals: Associations with body dissatisfaction, eating disorder symptoms, and muscle dysmorphic symptoms in at risk sexual minority men

Eating Disorder Clinical Presentation and Treatment Outcomes by Gender Identity Among Children, Adolescents, and Young Adults

PURPOSE

Current eating disorder treatment approaches for youth were developed for use with cisgender girls, which limits the understanding of effectiveness for cisgender boys and transgender and gender expansive (TGE) youth. Here, we compare treatment outcomes for cisgender boys and TGE youth with cisgender girls receiving family-based treatment for an eating disorder.

METHODS

Patients were aged 6-24 and either active in treatment or discharged from September 1, 2020, to November 1, 2022 (N = 1,235). Patient exposure to treatment varied given individualized length of treatment. Outcomes include eating disorder symptoms, depression, anxiety, suicidality, caregiver burden, and parental confidence in supervising treatment. Treatment outcomes for cisgender boys and TGE youth were compared with cisgender girls.

RESULTS

Patients included n = 975 cisgender girls, n = 152 cisgender boys, and n = 108 TGE youth. Anorexia nervosa was the most common diagnosis. Cisgender boys reported significantly lower eating disorder (b = -2.7 [-4.1, -1.3]), anxiety (b = -1.6 [-2.2, -0.9]), and depression (b = -1.7 [-2.4, -0.9]) symptoms at admission compared with cisgender girls. TGE patients had significantly higher anxiety (b = 1.08 [0.28, 1.91]) and depression (b = 1.72 [0.78, 2.65]) symptoms compared with cisgender girls. Cisgender boys started with significantly lower suicidal ideation (b = -1.28 [-2.19, -0.43]) and TGE patients with significantly higher suicidal ideation (b = 1.63 [0.76, 2.51]) than cisgender girls. All symptoms improved during treatment and improved at similar rates over time in treatment regardless of gender identity.

DISCUSSION

Early evidence from this study supports the use of family-based treatment for cisgender boys and TGE youth with eating disorders. Further research is needed on the long-term outcomes of this approach for youth of all genders.

Dissonance-Based Eating Disorder Prevention for Body-Dissatisfied Brazilian Cisgender Gay and Bisexual Men: A Randomized Controlled Trial With a 1-Year Follow-Up

OBJECTIVE

Gay and bisexual men are at an increased risk for eating disorders (EDs) and muscle dysmorphia (MD) compared with their heterosexual counterparts. Existing dissonance-based (DB) EDs prevention programs for this population have been evaluated in the United States; however, these programs have not been evaluated in the Brazilian context. Thus, we investigated the feasibility, acceptability, and efficacy of a DB ED prevention program (i.e., the PRIDE Body Project) among Brazilian cisgender gay and bisexual men.

METHOD

Eligible men were randomly assigned to either a DB intervention (n = 74) condition or an assessment-only control (AOC) condition (n = 75). Participants completed measures assessing ED and MD risk and protective factors at baseline, post-intervention, 1-month, 6-month, and 1-year follow-up. Those in the intervention condition also completed acceptability measures.

RESULTS

Feasibility and acceptability ratings were highly favorable. Regarding efficacy, post-intervention results were not significant, except for self-objectification, which showed a significantly greater decrease in the DB condition compared with the AOC condition at all time-points of follow-ups (Cohen's d = -0.31 to -0.76). At follow-up, the DB condition showed significantly greater decreases in appearance-ideal internalization, drive for muscularity, self-objectification, ED and MD symptoms at 1-month, 6-month, and 1-year follow-ups (d = -0.33 to -0.92) compared with the AOC condition. Significant increases were observed in the DB compared with the AOC condition for body appreciation at 1-month, 6-month, and 1-year follow-ups (d = 0.31-0.81).

DISCUSSION

Results support the feasibility, acceptability, and efficacy of the PRIDE Body Project up to 1-year in Brazilian cisgender gay and bisexual men.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR-62fctqz.

Psychometric properties of the Spanish version of the functionality appreciation scale

BACKGROUND

The Functionality Appreciation Scale is a 7-item measure of an individual's appreciation of his or her body for what it can do and is capable of doing. While this instrument has been increasingly used in intervention-based research, its psychometric properties have not been extensively studied in non-English-speaking populations. The psychometric properties of a novel Spanish translation of the FAS were examined.

METHODS

An online sample of 838 Spanish adults (mean age = 31.79 ± 11.95 years, 50.48% men) completed the Spanish FAS and validated measures of body appreciation, eating disorder symptomatology, intuitive eating, and life satisfaction.

RESULTS

Exploratory factor analysis supported a 1-dimensional factor structure of the FAS, which was further supported by confirmatory factor analysis (SBχ²(14) = 83.82, SBχ²normed = 1.48, robust RMSEA = 0.094 (90% CI = 0.074, 0.115), SRMR = 0.040, robust CFI = 0.946, robust TLI = 0.924). Invariance across genders was shown, and there were no significant differences according to gender (t(417) = 0.77, p =.444, d = 0.07). Construct validity was also supported through significant associations with the other measures of the study. Incremental validity was established in women. Thus, appreciation of functionality predicted life satisfaction over and above the variance accounted for by other body image and eating disorder-related measures (F(4, 399) = 18.86, p <.001, ΔR2 = 0.03).

CONCLUSIONS

These results support the psychometric properties of the Spanish FAS and demonstrate the importance of the appreciation of functionality in relation to a healthier body image and psychological wellbeing.

Identifying methods used to manage weight and shape by first year university students: A qualitative analysis

OBJECTIVE

To identify current strategies used by first-year university students to lose weight, maintain weight, or change their body shape.

METHODS

First-year university students (n = 661) completed an open-ended, web-based survey. Cross-sectional data were analyzed qualitatively using a reflexive thematic approach to identify strategies used to lose weight, maintain weight, or alter body shape/composition. Thematic maps were constructed for each weight- and shape-related goal.

RESULTS

Four main types of strategies were used to achieve all three weight or shape-related goals among first-year college students: changes in diet, changes in exercise, self-monitoring, and disordered eating. One behavioral strategy observed across all weight-related goals was prioritizing protein consumption, including protein gained from supplementation. However, there were also differences in strategies by weight- or shape-related goal. For example, only participants aiming to lose or maintain weight reported mindful strategies for monitoring diet. Individuals aiming to alter body composition reported heterogeneity in goal-related intentions, targeting specific body parts through exercise, and extensive supplement use.

CONCLUSIONS

First-year college students use a variety of strategies to manage their weight and shape. Some strategies were observed across goals, whereas others are specific to the weight- or shape-related goal. More research is needed to understand the impacts, both positive and negative, of using the strategies identified in the present study.

Eating disorders among queer and trans individuals: Implications for conceptualization, assessment, and treatment

Eating disorders (EDs) have been traditionally viewed as a disorder affecting cisgender, heterosexual women. Yet, the prevalence of EDs among queer and trans (QnT) individuals, coupled with the lack of interventions that attend to contextual factors related to sexual orientation and gender identity, underscore a critical health disparity issue requiring urgent attention. Here, we first review factors pertaining to QnT individuals' minoritized sexual and gender identities that are important to consider in ED conceptualization for this population (e.g., minority stressors, identity-based body image standards). Next, we describe problematic assumptions present in existing ED assessment and propose more inclusive approaches. Lastly, we provide suggestions for practices that providers can implement within their treatment of EDs among QnT individuals.

Status, sexual capital, and intraminority body stigma in a size-diverse sample of gay men

Gay men are more likely than heterosexual men to experience social pressure based on body weight, shape, and muscularity, which may drive disparities in body image concerns and eating disorders. Utilizing a sample of 1723 gay men living in the United States, the present study examined whether sociodemographic factors (used as proxies for status and sexual capital) and frequency of attending gay-specific establishments or gatherings (community involvement) were associated with gay men's experiences of negative or discriminatory pressures based on body size and shape specifically from other gay men (intraminority body stigma). Experiences of intraminority body stigma were significantly more common among gay men who identified as higher-weight (r = 0.28), less masculine (r = -0.21), less wealthy (r = -0.21), younger (r = -0.21), or people of color (ds = 0.25-0.28). Furthermore, indicators of low status and sexual capital were indirectly associated with less frequent community involvement via more frequent experiences of intraminority body stigma. In addition to frequency, the valence of interactions between gay men should be considered when assessing body image and eating disorder risk in this population. Future research is encouraged to examine intraminority body stigma as an intersectional source of intraminority stress to inform prevention and treatment efforts for gay men.

Associations between body image patterns and body image-related pathology in sexual minority individuals: A mixture-modeling approach

Body image concerns are associated with disordered eating, body dysmorphic disorder (BDD), and illicit appearance and performance enhancing drug (APED) misuse. Sexual minority individuals are a vulnerable population for body image concerns. Latent profile analyses were used to identify body image patterns in sexual minority men (n = 479) and women (n = 483) and to investigate associations between latent profiles and body image-related pathology. A 5-profile solution demonstrated best fit for men and a 4-profile solution for women. Among women, co-occurring high thinness/muscularity concerns had higher probability of vomiting and dietary restriction than the high thinness/low muscularity concerns profile. The probability of driven exercise did not differ across latent profiles for men and only differed between low thinness/low muscularity and high thinness/high muscularity concerns profiles in women. Men with low thinness/high muscularity concerns had significantly lower probability of vomiting and laxative misuse than all other profiles but did not significantly differ from co-occurring high or moderate thinness/muscularity concerns profiles in binge eating and illicit APED misuse. This study may have implications for future research, treatment, and prevention of body image-related pathology in sexual minority individuals.

Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory

There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.