Eating and body image disturbances across cultures: a review

Associations Between Body Image, Eating Behaviors, and Diet Quality Among Young Women in New Zealand: The Role of Social Media

Background/Objectives: This study investigates the relationship between diet quality and body image disturbance among young women aged 18-24, a crucial period for establishing lifelong health behaviors. Given the increasing exposure to social media, which often promotes unrealistic beauty standards, this research aims to explore associations between eating behaviors, diet quality, and body image disturbance. Methods: A mixed-methods approach was employed, combining qualitative focus group discussions with quantitative analysis. Focus groups (n = 19) explored themes of body image dissatisfaction. The Body Image Disturbance Questionnaire (BIDQ) was administered to 50 participants (young women aged 18-24) to quantitatively assess body image disturbance, while diet quality was evaluated using the Australian Recommended Food Scores (ARFS). The Three-Factor Eating Questionnaire (TFEQ-R18) was also used to assess eating behaviors, including cognitive restraint, uncontrolled eating, and emotional eating. A social influence questionnaire (SIQ) was administered to measure the effect of social influence. Pearson's correlation coefficient was used to determine the relationship between ARFS, BIDQ, and TFEQ-R18 scores. Results: Qualitative findings revealed persistent dissatisfaction with body shape, largely influenced by social media. Quantitatively, 65% of participants scored above the clinical threshold for body image disturbance (mean BIDQ score = 4.2, SD = 0.8). The correlation between ARFS and BIDQ scores was weak and not statistically significant (r = 0.057, p = 0.711). However, a significant positive correlation was observed between time spent on social media and body image disturbance (r = 0.58, p < 0.01). Additionally, TFEQ-R18 results indicated that 45% of participants displayed moderate levels of uncontrolled eating, and 36.5% demonstrated moderate levels of emotional eating. Conclusions: While social media is associated with body image concerns, its effect on eating behaviors and diet quality shows weak correlations, suggesting that other factors may mediate these outcomes. These results suggest the complexity of the associations between body image, eating behaviors, and diet quality, indicating that interventions should consider psychological drivers behind these concerns alongside social media usage.

Positive Body Image and Psychological Wellbeing among Women and Men: The Mediating Role of Body Image Coping Strategies

This study aimed to examine the mediating role of body image coping strategies in the relationship between positive body image and wellbeing. Three hundred and seventy-two women and three hundred and seventy-seven men completed a questionnaire assessing body appreciation, body appreciation functionality, body compassion, body image coping strategies (appearance fixing, avoidance, positive rational acceptance), self-acceptance and overall psychological wellbeing. Path analysis showed that avoidance significantly mediated the relationship between body appreciation and overall psychological wellbeing among both women and men; its mediating role was confirmed for men's but not for women's self-acceptance. Positive rational acceptance was a significant mediator of the relationship between body compassion and both psychological wellbeing and self-acceptance among men but not among women. These findings show that higher body appreciation is associated with a lower tendency to avoid appearance-related cognitions or thoughts that are interpreted as threatening, with an indirect effect on women's and men's psychological wellbeing. Analogously, but only for men, body compassion is associated with mental activities and self-care behaviors that foster rational self-talk and the acceptance of one's experiences, which, in turn, are linked to higher wellbeing. These findings can help to plan programs aimed at fostering individuals' wellbeing by focusing on their positive body image considering gender differences.

My mother, sisters, and I: Investigating the role of female family members in body dissatisfaction and disordered eating behaviours among young Middle-Eastern women

The global rise in body dissatisfaction and disordered eating concerns is apparent; however, limited research in Middle-Eastern populations gives an incomplete understanding of these concerns. The present study recruited 377 young women aged 18 to 25 years from the Middle-East for an online survey to determine how female family members may contribute to body dissatisfaction and disordered eating behaviours. Guided by the Tripartite Influence Model, we investigated the relationships between appearance pressures and fat talk, from mothers and sister(s), in predicting body dissatisfaction, and in turn, disordered eating symptomatology (restriction and bulimia), as mediated by appearance comparisons and internalisation of the thin-ideal. Overall, greater appearance pressures and fat talk from mothers and sister(s) were associated with body dissatisfaction and disordered eating symptomatology. Greater reported closeness in mother-daughter relationships, but not sister relationships, was associated with less perceived appearance pressure and fat talk by mothers, and lower appearance comparisons, body dissatisfaction and bulimia symptomatology. Finally, participants perceived greater appearance pressure from their mothers than their sister(s), but there was no difference in their perceived levels of fat talk. Findings demonstrate the applicability of a subsection of the Tripartite Influence Model in a non-Western and understudied population, namely in young Middle-Eastern women.

Assessing severity in anorexia nervosa: Do the DSM-5 and an alternative severity rating based on overvaluation of weight and shape severity differ in psychological and biological correlates?

OBJECTIVE

This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables.

METHOD

A sample of 312 treatment-seeking patients with AN (mean age = 25.3, SD = 7.6; mean BMI = 16.8 kg/m² , SD = 2.4) were categorised using both DSM-5 severity levels (mild/moderate/severe/extreme) and weight/shape (low/high) overvaluation. The severity categories were compared on a range of psychological (e.g., eating psychopathology) and biological (e.g., sodium) variables.

RESULTS

Results showed that the overvaluation of weight/shape appeared better at indexing the level of severity in psychological variables among patients with AN compared to the DSM-5 severity rating with moderate to large effect sizes. Moreover, the DSM-5 mild and moderate severity groups experienced significantly higher eating and general psychopathology than the severe and extreme groups. Finally, neither the DSM-5 nor the weight/shape severity groups differed on any of the biological variables.

CONCLUSIONS

This study provided no support for the DSM-5 severity rating for AN, while initial support was found for the weight/shape overvaluation approach in indexing psychological but not biological correlates.

Asian students in the anglosphere - unravelling the unique familial pressures contributing to eating pathology: a systematic review

BACKGROUND

There is no clear consensus on the specific familial pressures affecting Asian students in the Anglosphere, despite the validation of the Tripartite Influence model of eating disturbances in this group. However, traditional familial risk factors for disordered eating can be elevated for immigrant Asians with collectivistic-oriented familial dynamics, necessitating an examination of the culture-specific risk profile for eating pathology in student-aged Asians. This systematic review aims to consolidate and critically examine the literature on the most widely studied familial pressures related to disordered eating in Asian students in the Anglosphere.

METHODS

A systematic search was conducted in five databases for peer-reviewed articles measuring familial pressures and eating pathology in Asian students > 10 years old from an Anglosphere country. Following PRISMA guidelines, papers were screened by title, abstract and full text based on the eligibility criteria. Eligible studies were qualitatively analysed and synthesised narratively to assess the relationship between familial pressures and eating pathology.

RESULTS

In total, 14 papers were eligible for inclusion in the review. Eight topics related to familial stressors were identified (1) intergenerational conflict; (2) lack of familial cohesion; (3) parental overprotection; (4) low parental care; (5) familial achievement orientation; (6) parental expectations; (7) parental criticism; and (8) direct parental influence. In multiple studies, intergenerational conflict, maternal overprotection, and familial achievement orientation were significantly elevated and associated with disordered eating in US and UK Asian students, compared to white students. The studies examining parental criticism and familial cohesion had more heterogeneous findings.

CONCLUSION

The findings demonstrate the perception of Asian parenting styles as overprotective and incompatible with individualist-oriented Western values could increase eating pathology in adolescent and university students living in Anglosphere countries. The synthesised findings of the literature also indicate disordered eating acts as a compensatory mechanism for the ongoing psychological distress generated from intergenerational conflict and familial achievement orientation. Conversely, traditional eating disorder literature on familial cohesion and low parental care may not be applicable to young Asians. Future research should focus on how social appearance anxiety and psychological factors can mediate the link between disordered eating and familial stressors in Asian students.

Cognitive Defusion and Psychological Flexibility Predict Negative Body Image in the Chinese College Students: Evidence from Acceptance and Commitment Therapy

Body dissatisfaction is a global phenomenon. Despite the significant cultural difference, most research on negative body image was conducted in Western countries. How do cognitive fusion and psychological flexibility relate to negative body image in the Chinese population? In the present study, this question was investigated through the intervention technique, Acceptance and Commitment Therapy (ACT). Here, 86 young Chinese university students with high negative physical self were invited, in which 42 students received 10 sessions of group-based ACT intervention in a clinical setting while the remained acted as the control group with no intervention. Pretests showed no statistical differences in negative body image between these two groups, while both cognitive fusion and psychological flexibility predicted negative body image. Post-pre tests showed no change in the control group, while enhanced cognitive defusion and psychological flexibility in the ACT group. Individual differences in psychological flexibility and cognitive defusion enhancement predicted improved body image. A strong association of implicit body image with Fatness and Shortness changes suggested that although with individual differences, those components could be internalized during the intervention in the College students.

Face yourself: The social neuroscience of mirror gazing

In philosophical and psychological accounts alike, it has been claimed that mirror gazing is like looking at ourselves as others. Social neuroscience and social psychology offer support for this view by showing that we use similar brain and cognitive mechanisms during perception of both others’ and our own face. I analyse these premises to investigate the factors affecting the perception of one’s own mirror image. I analyse mechanisms and processes involved in face perception, mimicry, and emotion recognition, and defend the following argument: because perception of others’ face is affected by our feelings toward them, it is likely that feelings toward ourselves affect our responses to the mirror image. One implication is that negative self-feelings can affect mirror gazing instantiating a vicious cycle where the negative emotional response reflects a previously acquired attitude toward oneself. I conclude by discussing implications of this view for psychology and social studies.

Body image distortion among Brazilian and Portuguese women with children: A comparative study between the ELSA-Brasil and Generation XXI cohorts

Solid evidence indicates that body image distortion is associated with various physical and mental health problems in women (e.g. Lee and Lee, 2016; Mölbert et al., 2017; Raj and Ploriya, 2020; Sagar, 2005; Shin et al., 2015). Furthermore, body image has been shown to vary according to life context and stage, particularly after a woman has had children. This scenario justifies the comparison between different countries and cultures. The objective of the present study was to evaluate the prevalence and associated factors of body image distortion/accuracy in Brazilian and Portuguese women with children. The study assessed women selected from two epidemiological cohorts: ELSA-Brasil in Brazil (n = 1468) and Generation XXI in Portugal (n = 3380). The data analyzed were based on multidimensional questionnaires from which sociodemographic and family characteristics as well as data associated with lifestyle and health were obtained. The results show that most women in both cohorts had an accurate perception of their own body size. In cases of distorted self-perception, the likelihood of the Brazilian women perceiving themselves as being heavier was greater if they had had cancer, whereas the Portuguese women were less likely to perceive themselves as heavier when they had less schooling. Perceiving themselves as thinner than they actually are, was associated with poorer self-perception of their own state of health in the Brazilian women and with poorer schooling in both the Brazilian and Portuguese women. The present findings contribute towards improving understanding of the influence of body image distortion on the health and wellbeing of Brazilian and Portuguese women, possibly leading to the implementation of health-promoting policies in both countries.

Media pressure and the process of Westernization in the context of body self-assessment among young heterosexual and gay Polish men

Mass media and social networks portray a unified image of the perfect male body. The intensity and universality of this influence is an important element of the process of Westernization, especially in traditional cultures such as that of Poland. The main aim of the present study was to investigate the differences between Polish gay and heterosexual men in terms of the role played by self-esteem and the level of internalization of sociocultural standards of body appearance as predictors of the development of their body images. The research study was conducted by reference to 19- to 29-year-old Polish heterosexual (n = 287) and gay (n = 97) men. The variables were measured using Polish versions of the Sociocultural Attitudes towards Appearance Scale-3, the Self-Esteem Scale, and the Multidimensional Body–Self Relations Questionnaire. Statistical analyses identified several variables as the main predictors of body image in both heterosexual and gay young men: self-esteem, information-seeking, perceived pressure and the internalization of sociocultural standards regarding an athletic body image drawn from mass media. The only significant difference between the two groups was the fact that self-esteem, perceived pressure and the internalization of sociocultural standards from mass media did not play a predictive role with respect to Appearance Orientation among the group of gay men.

Earlier Age at Menarche Is Associated with Body Fat and Negative Body Image in Adult Life

Earlier age at menarche is one of the well-documented antecedents of a range of adverse health effects in adulthood including obesity and psychopathological effects. Yet, few researchers have examined the potential association of menarcheal age with body fat distribution, self-perception, and body image. We retrospectively tested a sample (N = 392) of adult women (18-80 years) to examine the associations of age at menarche with body composition and body image indices. Analyses of covariance and multivariable logistic and linear regression were fitted adjusting for age, physical activity level, smoking, and alcohol consumption. Further adjustment was made for body mass index (BMI) and percentage of fat mass. Earlier age at menarche was associated with slightly increased odds of higher BMI and abdominal fat percentage; of note is the positive correlation with lower body composition indices including hip and calf circumferences/skinfolds. Additionally, earlier age at menarche was associated with higher scores in the negative body image scales, namely overweight preoccupation and self-classified weight, whereas lower risks were found for higher scores in the positive body image scales, namely appearance evaluation and body area satisfaction scales. These findings remained significant after correcting for body fat percentage. The present results showed positive associations for earlier age at menarche with gross indices of obesity with the associations mainly confined to distribution of body fat in the lower part of the body, whereas an increased risk of negative body image was also found. Future research could refine our understanding of the biological and psychological mechanisms underlying these associations.

Type 1 diabetes youth with disordered eating: Is there a disproportionate impact on ethnic minorities and indigenous peoples?

Adolescents with type 1 diabetes mellitus consistently have suboptimal glycaemic control and worse outcomes, and this is especially true for adolescents from indigenous communities and ethnic minorities. It is increasingly recognised that disordered eating is common in adolescents and likely causes a disproportionate impact on glycaemic outcomes and psychological morbidity. Eating disorders may be even more common in indigenous and ethnic minority populations and be another reason why it is harder to achieve recommended glycaemic targets in this group. In this viewpoint, we explore the issues around disordered eating in this vulnerable group, the difficulties in diagnosis and the challenges in management. We focus in particular on the outcomes in the more disadvantaged adolescents with type 1 diabetes, especially indigenous groups and ethnic minorities, an area where there have been few publications and generally less recognition to date.

Young adult mental health sequelae of eating and body image disturbances in adolescence

OBJECTIVE

There has been interest in the antecedents and mental health impacts of eating and body image disturbances in adolescence. Less is known about longer-term mental health impacts into young adulthood, as longitudinal studies with data spanning this developmental period are rare. We capitalize on mental health data collected across adolescence and young adulthood from a population-based cohort study that has been following >2000 Australian children and their families from infancy to young adulthood.

METHOD

This sample comprised 1,568 participants who completed the Eating Disorder Inventory drive for thinness and bulimic behavior (the severity of binge-purge patterns) subscales, and a modified version of the body dissatisfaction subscale in mid-adolescence (15-16 years), or the Depression Anxiety Stress Scales in young adulthood (19-20, 23-24, and 27-28 years).

RESULTS

After adjusting for baseline demographic and prior mental health factors (<13 years of age), all three indices of eating and body image disturbances in adolescence predicted each mental health outcome in young adulthood. Mental health risks associated with adolescent body dissatisfaction and bulimic behavior scores remained stable across young adulthood, with men having more pronounced problems associated with bulimic behavior scores than women. In contrast, mental health risks associated with adolescent drive for thinness scores diminished across this period similarly for men and women.

DISCUSSION

Findings suggest that adolescent eating and body image disturbances may have long-term mental health impacts that extend into young adulthood. This underscores the need for early preventative intervention, and longer-term monitoring and support for body image and eating disturbances.

A qualitative exploration of motivations for fasting and the impact of Ramadan on eating behaviors and body image among young adult Muslim women in the United Kingdom

Research exploring the impact of fasting in Ramadan on eating behaviors has focused on Muslim-majority countries and has neglected to examine impacts beyond the month when "normal" eating patterns resume. This study aimed to explore the experiences of United Kingdom-residing young adult Muslim women who were fasting in Ramadan to understand its impact on their body image and eating behaviors both during and 1-month following Ramadan. In-depth, semi-structured interviews were conducted with 14 Muslim women aged between 18 and 35 (Mage = 27.3) at two distinct time-points: during the last week of Ramadan and 1-2 months later. The interviews explored questions related to motivations for fasting, experience of fasting in Ramadan, and eating behaviors and thoughts related to body image and appearance. Thematic Analysis revealed three themes: (1) family and community expectations to fast (2) exertion of control of on eating behaviors and (3) preoccupation with weight and appearance. The results suggest that family and community play a strong role in motivating women to fast during Ramadan, alongside the need to feel a sense of belonging to their community. This can conflict with the pressure and desire to assimilate with Western culture and associated appearance ideals, thus putting women at greater risk of disordered eating and body image concerns. These findings suggest important implications for increased support in the Muslim community, and the need for further research to explore this topic across longer time-points and in different cultural groups.

Body Dissatisfaction, Weight-Related Behaviours, and Health Behaviours: A Comparison Between Australian and Malaysian in Female Emerging Adults

The presence of body dissatisfaction (BD) in non-Western countries is an important area of empirical enquiry. The results reflect collectivistic and individualistic cultures of Malaysians and Australians, respectively, whereby social approval, social acceptance, and cultural values are of high importance to Malaysians compared with the more liberal attitudes of Australians with respect to health behaviours. This study sought to compare: (1) Australian and Malaysian women on BD, thin ideal internalisation, sociocultural influences, problematic weight-related behaviours, and health behaviours; and (2) the degree to which BD is associated with health behaviours (smoking, alcohol consumption, drug use, and sexual behaviours) across the two cultures. Participants were 428 Australian females and 402 Malaysian females aged 18–25 years old. Australians had higher BD, thin ideal internalisation, family and media influences, restrained eating, and poorer health behaviours, while Malaysians had higher peer influence. There was no difference for bulimic behaviours across the two countries. BD was found to have an association with use of drugs, smoking, and sexual behaviours among Malaysian women, but not for Australian participants. The permeation of Western standards of the thin ideal due to increased industrialisation, Westernisation, and modernisation has brought about bulimic behaviours in Malaysian women, similar to that of Australian women.

Estimated prevalence of eating disorders in Singapore

OBJECTIVE

There is a lack of research on the prevalence of eating disorders (EDs) in Singapore. The aims of our study were to (a) estimate the prevalence of EDs, risk status, and help-seeking behaviors among adults in Singapore, (b) examine gender differences between ED status groups, and (c) characterize clinical profiles of ED status groups.

METHOD

We administered a cross-sectional survey that included a validated EDs screening tool to adults in Singapore.

RESULTS

A total of 797 Singaporean adults ages 21-77 years completed the ED screen. The majority of participants screened positive for a current DSM-5 clinical ED (6.2%), other specified feeding or ED (37.0%) or at high risk of developing an ED (19.5%). Only 1.6% of those who screened positive for an ED reported currently being in treatment. The ratio of males to females who screened positive for an ED was nearly 1:1. The clinical profiles of ED groups were consistent with the clinical presentations found in Western nations.

DISCUSSION

This is the first study in Singapore to estimate the prevalence of EDs in a large sample of adults. Results highlight the urgent need for more ED research and expansion of prevention and treatment programs to address the high prevalence of ED psychopathology in Singapore.

The comorbidity of eating disorders in bipolar disorder and associated clinical correlates characterised by emotion dysregulation and impulsivity: A systematic review

BACKGROUND

Individuals with bipolar disorder (BD) have an increased risk of developing eating disorders (ED) or disordered eating symptoms compared to the general population. Eating pathology characterised by binge and/or purge symptomatology are the most common to develop in BD, yet the underlying aetiological mechanisms are relatively unknown. Theoretical models of BD-ED comorbidity suggest that shared pathophysiological factors, including emotion dysregulation and impulsivity may contribute to the development of binge/purge eating pathology in BD.

METHOD

A systematic search was conducted to assess two research questions: 1. What are the prevalence or incidence rates of different ED in BD? 2. Are clinical correlates hallmarked by emotion dysregulation and/or impulsivity (alcohol/substance use disorders, mood instability and suicidality) significantly elevated in BD with ED (BD-ED) groups compared to BD only?

RESULTS

Any type of lifetime or current ED ranged from 1.9% to 33.3% in BD. Type of BD diagnosis did not appear to significantly impact likelihood of ED development. Alcohol use disorder, mood instability and suicidality were significantly higher in BD-ED compared to BD only.

LIMITATIONS

Potential biases within the selected studies; impacting generalisability of results and comparability between studies. Varying treatment interventions (including medications) may confound results and comparability between studies. Assessment of binge eating varied, also limiting comparability.

CONCLUSION

Eating pathology may occur comorbidly with BD due to shared underlying pathophysiological features. This could have significant implications for future interventions; both psychopharmacological and psychotherapeutic. More comprehensive investigations are required to identify the functionality of dysregulated emotion and impulsivity in the development of eating pathology in BD.

Association of Health Status and Health Behaviors with Weight Satisfaction vs. Body Image Concern: Analysis of 5888 Undergraduates in Egypt, Palestine, and Finland

Little is known about the relationships between weight satisfaction, body image concern, healthy nutrition, health awareness, and physical activity among college students across culturally different countries. We assessed country and sex-specific associations between health status (self-rated health, depression, BMI), healthy behavior (healthy nutrition, physical activity, health awareness), weight satisfaction, and body image concern via a cross-sectional survey (5888 undergraduates) in Egypt, Palestine, and Finland. This health and wellbeing survey employed identical self-administered paper questionnaires administered at several Universities in two Eastern Mediterranean countries (Egypt, Palestine—Gaza Strip), and an online-survey comprising the same questions in Finland. Regression analyses were employed. Health status variables exhibited the strongest associations; high BMI and more depressive symptoms were more often among students satisfied with their weight (except in Palestine), but they were positively associated with body image concern irrespective of country or gender. Self-rated health was not associated with body image concern or weight satisfaction. Healthy behaviors were not associated with body image concern or weight satisfaction. Depressive symptoms and BMI were the most prominent predictors for body image concern. There were country-specific consistent results when using the body image concern score. Further research is necessary to compare body image across different cultures and countries.

The Relationship between Sense of Coherence, Stress, Body Image Satisfaction and Eating Behavior in Japanese and Austrian Students

Background: Restrained, emotional, and external eating are related to obesity and eating disorders. A salutogenic model has confirmed sense of coherence (SOC) as a health resource that moderates stress and helps limit the occurrence of overweightness and eating disorders. This study aimed to examine the relationship between SOC, social support, stress, body image satisfaction (BIS) and eating behaviors in different cultural environments. Methods: A total of 371 Austrian (161 men, 210 women) and 398 Japanese (226 men, 172 women) university students participated. The SOC-13 scale, Multidimensional Scale of Perceived Social Support, Dutch Eating Behavior Questionnaire, BMI-Based Silhouette Matching Test and an analogue single-stress item were used as measurements. Results: SOC negatively affected all three types of eating in Austrian students (men: β = −0.227 to −0.215; women: β = −0.262 to −0.214). In Japanese students, SOC negatively affected external eating in both sexes (men: β = −0.150; women: β = −0.198) and emotional eating (β = −0.187) in men. BIS indicated that the desire to become slim predicted restrained eating, women’s emotional eating, and men’s and Austrian women’s external eating. Stress was only predictive of emotional eating in Japanese men. Conclusions: This study found that SOC, BIS and stress might be valuable factors regulating eating behavior in a cultural context. However, the relationship between SOC, BIS, stress and eating behavior differs between cultures.

Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman's Experiences of Bulimia Nervosa

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of 'bulimia.' It thereby offers an alternative portrait of relationships between eating disorders and 'culture,' one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment.

Culture Change and Eating Patterns: A Study of Georgian Women

Introduction: Immigration and culture change have been thought to affect various aspects of psychological well-being, including eating behaviors. This study aimed to examine the association between immigration, acculturation strategies and eating patterns. Materials and Methods: Acculturation was conceptualized and measured by acculturation strategies of integration (maintaining original culture and adopting the new culture), assimilation (adopting the new culture and leaving behind the old), separation (sticking with the original culture only) and marginalization (maintaining/adopting neither culture). Eating patterns were conceptualized by dietary restriction, eating concern, shape concern, and weight concern. Links between demographic variables, acculturation strategies, and eating patterns were also examined. Five hundred and six Georgian women took part in the study: 253 living abroad (UK and USA) and 253 living in Georgia. Measures included East Asian Acculturation Measure (EAAM) for acculturation strategies (assimilation, integration, separation, and marginalization subscales) and Eating Disorder Examination Questionnaire (EDEQ) for eating patterns (dietary restriction, eating concern, weight concern, shape concern subscales, and global score). Relevant demographic variables and Body Mass Index (BMI) were recorded. Results: Comparisons of immigrant and nonimmigrant groups using Multivariate Analysis of Covariance (MANCOVA) with BMI as a covariate found a difference in dietary restriction only, with immigrants yielding higher mean score than non-immigrants. The global EDEQ scores of immigrant and nonimmigrant groups were almost identical though. Correlations between separation and marginalization and four EDEQ scores were statistically significant and positive, while correlations between integration and two EDEQ subscales were marginally significant and negative. Regression analysis showed that separation and marginalization strategies of acculturation were significantly linked with EDEQ eating concern, shape concern, weight concern, and global scores thereby representing predictors of elevated eating outcomes. Discussion: Findings suggested that moving to Western countries increased dietary restriction among Georgian women. Furthermore, while living abroad, the lack of integration in a host culture, as a common denominator of separation and marginalization strategies of acculturation, may predict elevated eating, shape, and weight concerns among women relocated over six years ago. Acculturation conditions may also be linked with integration or well-being outcomes.

Cross-cultural, population-based study on adolescent body image and eating distress in Japan and Finland

This cross-sectional population-based survey compares the prevalence of self-reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross-cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self-reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three-way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.

Ethnic differences in body image perception in patients with type 2 diabetes

BACKGROUND

The present study compared the prevalence of obesity, fat distribution, body image perception and lifestyle among diabetic African and Albanian immigrants living in Italy, as well as diabetic Italians, aiming to identify health risks and their possible causes.

METHODS

The study sample consisted of 200 diabetic subjects living in Italy. A questionnaire regarding socio-demographic and lifestyle information was administered to participants, and anthropometric measurements and body image perception were assessed. Proper perception of weight status and the degree of dissatisfaction in body image perception were valued.

RESULTS

Italians showed a higher health risk, both with regard to anthropometric characteristics and lifestyle, whereas African immigrants showed a lower one. All of the male groups underestimated their weight and Albanians were the most dissatisfied. Women perceived their current body image as heavier than their desired body image, showing a dissatisfaction toward their weight. Subjects of both sexes belonging to the overweight and obese categories generally underestimated themselves; this was particularly true in obese Africans. People with a higher body mass index were more likely to be dissatisfied than those with a lower one. Body image dissatisfaction increased when people estimated themselves as being overweight. Among lifestyle habits, being an ex-smoker increased body image dissatisfaction.

CONCLUSIONS

The underestimation of weight detected in the present study requires attention. Nevertheless, the high percentage of overweight/obese people, coupled with the higher frequency of people dissatisfied with their high weight, suggests an awareness of the problem that could be more effective for weight loss.

Understanding Health, Violence, and Acculturation Among South Asian Women in the US

The devastating effects of experiencing violence in childhood are seen well into adulthood. This has been particularly difficult to assess among South Asians living in the U.S., due to a lack of disaggregated data on this ethnic group. In a web-based survey administered to a convenience sample of South Asian women living in the U.S. (n = 535), information was gathered on experience/exposure to childhood violence; adult intimate partner violence; and adverse health outcomes, including ever suicide ideation/attempt, experiences of quality of life and body esteem in adulthood. Further, an individual's acculturation levels were measured specifically looking at cultural identity which was guided by Berry's biculturalism model. This study found that acculturation status is a key factor with respect to childhood verbal, physical, and sexual abuse, as well as body esteem and an individual's well-being. These results suggest that acculturation plays a key role for childhood violence, as well as key adult health indicators. The findings in this study, suggest that more research is warranted to better understand the complex relationships between acculturation status and health. While studies of South Asian immigrants have increased substantially, the study on how acculturation influences family violence and health outcomes has lagged behind. The findings in this study will provide guidance for future work in understanding how acculturation can play a key role in addressing the health and well-being of South Asian women in the U.S.

Psychological and behavioural characteristics of females with anorexia nervosa in Singapore

PURPOSE

This study aimed to compare a sample of females with anorexia nervosa in Singapore with international clinical and population samples from published data in terms of endorsement of risk factors related to anorexia nervosa, severity of eating pathology and levels of psychosocial impairment and to explore the nature of the relationships between the anorexia nervosa risk factors and adherence to Asian cultural values.

METHOD

Data from the Eating Disorder Inventory-3 (EDI-3), the Eating Attitudes Test (EAT-26), the Perceived Sociocultural Pressure Scale (PSPS), the Ideal Body Stereotype Scale (IBSS), the Eating Disorder Examination Questionnaire (EDE-Q), the Clinical Impairment Assessment Questionnaire, and the Asian American Values Scale-Multidimensional (AAVS-M) were collected from 41 female patients (13-31 years old) who presented for treatment of anorexia nervosa at the Singapore General Hospital.

RESULTS

The profile and presentation of anorexia nervosa in Singapore was comparable to that observed in the Western clinical samples in terms of levels of endorsement of the risk factors for anorexia nervosa. No protective benefit of orientation to Asian culture was found.

CONCLUSION

The observed pattern of general similarity of presentation between Western data and Singaporean data, together with the finding that no protective benefit of orientation to Asian culture was observed, suggests that it may be appropriate to directly apply evidence-based Western models of intervention to the treatment of anorexia nervosa in Singapore.

Asian American Women’s Body Image Experiences

The purpose of our study was to explore Asian American women’s body image experiences from an intersectional framework. Utilizing grounded theory methodology, we sought to understand how gender and race intersect with unique experiences of oppression to contribute to body dissatisfaction among Asian American women. Twenty Asian American undergraduate women born in the United States participated in semi-structured interviews. The core category “body image” was composed of attitudes and perceptions about body weight, shape, and size; facial features (e.g., eye size); and skin complexion or tone. Five categories emerged that informed the body image experiences of Asian American women: (1) navigating cultural beauty norms, (2) experiences of sexism and racism, (3) parental influences, (4) peer influences, and (5) identity management processes. Each of these categories appeared to have both positive and negative consequences for appearance evaluation, ranging from self-consciousness to confidence. Participants also described coping strategies for managing these experiences. We encourage psychologists and clinicians to consider culture-specific beauty standards for Asian American women as well as salient racial and cultural factors (e.g., perceived discrimination and biculturative stress) that may influence body image beliefs. Our results offer a new model for understanding Asian American women’s body dissatisfaction as rooted in experiences of racism and sexism. 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

"Safe Foods" or "Fear Foods": the implications of food avoidance in college students from low- and middle-income countries

PURPOSE

The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge.

METHODS

This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants' diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms.

RESULTS

Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided.

CONCLUSION

Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

The Effects of Immigration and Media Influence on Body Image Among Pakistani Men

This study examined the role of media influence and immigration on body image among Pakistani men. Attitudes toward the body were compared between those living in Pakistan ( n = 56) and those who had immigrated to the United Arab Emirates ( n = 58). Results of a factorial analysis of variance demonstrated a significant main effect of immigrant status. Pakistani men living in the United Arab Emirates displayed poorer body image than those in the Pakistan sample. Results also indicated a second main effect of media influence.Those highly influenced by the media displayed poorer body image. No interaction effect was observed between immigrant status and media influence on body image. These findings suggest that media influence and immigration are among important risk factors for the development of negative body image among non-Western men. Interventions designed to address the negative effects of the media and immigration may be effective at reducing body image disorders and other related health problems in this population.

Eating psychopathology and psychosocial impairment in patients treated at a Singapore eating disorders treatment programme

INTRODUCTION

There is limited data on the psychopathology of eating disorders in Singapore. This study: (a) described levels of eating psychopathology and psychosocial impairment among individuals diagnosed with eating disorders at our hospital; and (b) compared the related psychopathology of these patients.

METHODS

Between 1 August 2010 and 31 July 2012, 257 individuals who met the diagnostic criteria for eating disorders completed the Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment questionnaire (CIA).

RESULTS

A majority of participants were women and of Chinese ethnicity. Diagnoses included anorexia nervosa (AN; 41.6%), bulimia nervosa (BN; 29.6%) and eating disorder not otherwise specified (EDNOS; 28.8%). Mean age at presentation was 20.52 ± 7.14 years and mean body mass index was 17.84 ± 4.18 kg/m². Individuals with AN were significantly younger at presentation and had shorter duration of untreated illness compared to those with BN and EDNOS. There were no significant differences in the CIA scores of the diagnostic groups. Participants with BN scored higher in all subscales of the EDE-Q than those with AN and EDNOS. Our sample scored lower in most subscales of EDE-Q when compared to treatment centres in Sweden, Australia and the United States.

CONCLUSION

Our clinical sample reported lower scores of psychopathology compared to overseas centres. This could be attributed to the higher percentages of BN and EDNOS diagnosed in overseas populations. Individuals with AN showed higher levels of psychopathology in our study compared to patients from the United States.

Eating symptomatology and general psychopathology in patients with anorexia nervosa from China, UK and Spain: A cross-cultural study examining the role of social attitudes

Cultural studies exploring differences in the manifestation of anorexia nervosa (AN) have primarily focus on Western and non-Western cultures. However, no study so far has considered the role that social attitudes (i.e. Collectivist vs. Individualist cultural values) have in the clinical manifestations of eating disorders, including AN patients. With this in mind, the aim of this study is to compare eating and general psychopathology in a large sample of individuals diagnosed with AN from China, Spain, and United Kingdom (UK), in order to study the differences according to belonging to Western or non-Western country, or the country's Individualist Index (IDV). The total sample comprised on 544 adults with a diagnosis of AN recruited from People´s Republic of China (n = 72), UK (n = 117), and Spain (n = 355). Assessment measures included the Eating Disorders Inventory and the Symptom Checklist-90-Revised. Our results show significant differences in most of the eating and psychopathological indices between the three countries. Patients from Western societies (Spain and UK) share more similarities regarding psychopathological expression of AN than the non-Western country (China). While Western countries show higher levels of body dissatisfaction, somatization and overall psychopathology, Chinese patients tend to deny or minimize depression, anxiety and other psychopathological symptoms. Besides, the IDV shows cultural differences in the interpersonal sensitivity scale, being AN patients from UK (the more individualistic society) who presented with higher levels of interpersonal sensitivity (i.e. discomfort during interpersonal interactions and more negative expectations concerning interpersonal behavior). In conclusion, our findings suggest that psychopathological expression of AN is better explained by Western/Eastern influence than by individualist/collectivist values. Although the diagnosis for the eating disorder may be the same, differences in the psychopathology comorbid to the eating disorders may suggest the need for treatments to be modified according to the culture.

Culturally based health assumptions in Sub-Saharan African immigrants: Body mass index predicting self-reported health status

This study examined whether Sub-Saharan African adult immigrants maintained cultural preferences for curvier/higher body size post-migration to the United States. Linear and multiple regression analyses were utilized to discern the predicting effects of Sub-Saharan African immigrants' body mass index score on their self-reported health status at two post-migration data collection points. The initial assessment reveals that Sub-Saharan African immigrants' overweight body mass index score predicted better self-reported health status. Four to six years later, higher body mass index score predicted a better self-reported health status and lower dietary acculturation moderated the predicting effect of body mass index on self-reported health status. Limitations of the study and implications for research and practice are explored.

Stability of Body Image Concerns among Chinese Adolescents: Nine-Month Test-Retest Reliabilities of the Negative Physical Self Scale

This research assessed the stability of specific body image concerns among Chinese adolescents. A sample of 216 boys and 375 girls completed the Negative Physical Self Scale, a 38-item measure of body image concerns developed specifically for use in Chinese samples. Participants returned nine months later to complete the same scale. Bivariate correlation analyses within each sex obtained good test-retest reliabilities ( r = .48 to r = .78). Findings indicate that body image concerns of Chinese adolescents, especially those of girls, are relatively stable over a nine-month interval.

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.

Social Physique Anxiety in Adolescence: An Exploration of Influences, Coping Strategies, and Health Behaviors

This study explored adolescent females’ experiences of social physique anxiety (SPA) and related coping strategies. A final sample of 31 adolescent females ages 13 to 18 years discussed dealing with SPA during individual semistructured interviews. Resultant themes pertaining to the transactional experiences of SPA were coded using content analysis. There were 107 unique coping strategies reported, which were coded into 10 subthemes. The main coping categories included behavioral and cognitive avoidance, appearance management, diet, social support, physical activity, reappraisal, cognitive deflection and comparison to others, seeking sexual attention, and substance use. Informed by a stress and coping framework, it is evident that body-related thoughts and emotions are linked to various adolescent health behaviors.

Change in risk factors for eating disorder symptomatology in Malay students sojourning in the United Kingdom

OBJECTIVE

The purpose of this investigation was to examine change in risk for eating disorders in higher education students sojourning in the United Kingdom (UK), as well as associations between such risk and experiences in the host culture.

METHOD

Participants were 98 female students from Malaysia, who completed a measure of risk factors for eating disorder symptomatology (the Eating Disorder Inventory-3 subscales of drive for thinness, body dissatisfaction, and bulimia symptoms) at two time points: two months prior to beginning their sojourn in the UK (Time 1) and four months after the sojourn began (Time 2). At Time 2, participants also completed measures of sociocultural adjustment, cultural distance between home and host cultures, and perceived discrimination in the host culture.

RESULTS

Analyses indicated that, compared to scores at Time 1, participants had significantly higher drive for thinness (d = 0.64), body dissatisfaction (d = 0.54), and bulimia symptoms (d = 0.29) at Time 2. Poorer sociocultural adjustment and greater perceived discrimination significantly predicted greater risk of eating disorders at Time 2.

DISCUSSION

The stress associated with culture change may place sojourning students at risk for disordered eating. Further research is needed to determine the extent to which this risk is related to culture-change specifically, as opposed to a general set of factors associated with transition-related psychopathology more broadly. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:695-700).

Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients

This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown.

Thin-ideal internalization and body dissatisfaction in Sri Lankan adolescents

In this study, a survey of Sri Lankan adolescents explored relationships between thin-ideal internalization and body dissatisfaction-issues that have received greater research attention in East Asia and the West. Girls scored lower in thin-ideal internalization and awareness and higher in self-esteem compared to boys; however, unlike in previous studies, body dissatisfaction did not differ significantly by gender. Hierarchical linear multiple regression analyses revealed that self-esteem moderated the relationship between thin-ideal internalization and body dissatisfaction among girls, but this was not observed for boys. Self-esteem as a protective factor against body dissatisfaction among Sri Lankan female adolescents was confirmed.

Prevalence of Eating Disorders Among Adolescents in the Northwest of Iran

Background:

Perceived sociocultural pressure to be thin has an important impact on disordered eating during early and middle adolescence, but less is known about late adolescence. Adolescents face special problems that are less common during childhood. Several studies indicate that the prevalence of eating disorders has been increased among adolescents.

Objectives:

The aim of the present study was to investigate the occurrence, prevalence and correlates of eating disorders (ED) among adolescents in two cities of Iran, Urmia and Tabriz.

Patients and Methods:

This was a cross-sectional survey in which 1990 adolescent boys and girls were selected through multistage random sampling. The study was based on self-report questionnaires including eating attitudes test (EAT-26) and DSM-IV criteria for the presence of eating disorders. To analyze the obtained data we calculated measures of central tendency and dispersion, linear and logistic regression and Fisher’s exact test.

Results:

According to diagnostic criteria of EAT-26, 492 students (24.2%) were at risk of ED and scored above the recommended cut-off point on EAT-26. Among 1990 students, a total of 51 cases (0.25%) of eating disorder (14 anorexia nervosa, 18 bulimia nervosa, and 19 eating disorder not otherwise specified) were diagnosed.

Conclusions:

The obtained prevalence of ED in our study was higher than previous studies in Iran. We found high numbers of boys with ED. Overweight adolescents were shown to be more susceptible to strict dieting than normal-weight adolescents. These results suggest that it is necessary to provide screening and treatment services for Iranian adolescents. Further research is needed to develop intervention programs to control eating disorders among Iranian adolescents.

THE ASSOCIATION BETWEEN MENSTRUAL CYCLE CHARACTERISTICS AND PERCEIVED BODY IMAGE: A CROSS-SECTIONAL SURVEY OF POLISH FEMALE ADOLESCENTS

The increasing prevalence of negative body perceptions among adolescent girls and the tendency towards wishing to be thinner have become a cultural norm in Western culture. Adolescent girls are particularly vulnerable to developing a negative body image due to physical and sexual changes occurring during puberty. This study aimed to evaluate the association between different measures of body image perceptions and different phases of the menstrual cycle after controlling for weight status and other potential confounders in Polish adolescent girls aged 12-18 years. Three-hundred and thirty participants of a cross-sectional survey conducted in 2009, normally cycling and with no eating disorders, completed a background questionnaire and the Stunkard Figure Rating Scale, and their anthropometric measurements were collected. The dependent outcome variables were measures of body image (actual body image, ideal body image and ideal-self discrepancy) and dichotomous body image perception (satisfied versus dissatisfied) adjusted for other predictor factors: socio-demographic variables, menstrual history and cycle phases, and weight status. One-way ANOVA indicated that weight status, age at menarche and menstrual cycle phase were associated with actual body image and rate of ideal-self discrepancy. Ideal body image was associated with weight status and menstrual cycle phase. General logistic regression models were constructed to evaluate associations of body dissatisfaction and all potential predictor variables. The final selected model of the multiple logistic regression analysis using the backward elimination procedure revealed that adjusted for other factors, negative body image was significantly associated with different phases of the menstrual cycle (p trend=0.033) and increasing body weight status (p trend=0.0007). The likelihood of body dissatisfaction was greatest during the premenstrual phase of the menstrual cycle (OR=2.38; 95% CI 1.06, 5.32) and among girls in obesity class I (OR=8.04; 95% CI 2.37, 27.26). The study confirmed the association between body image dissatisfaction in adolescent girls and different phases of the menstrual cycle after controlling for weight status. The issue of negative body self-image is not only of cognitive, but also of practical value as understanding better the factors contributing to the formation of a negative body image may be instrumental in developing preventive health programmes targeted at young people.

Body satisfaction, thin-ideal internalization, and perceived pressure to be thin among Canadian women: The role of acculturation and religiosity

In an online study, 143 Canadian women of various religious backgrounds completed measures of acculturation, religiosity, body satisfaction, internalization of the thin ideal, perceived pressure from media, and manner of dress. Heritage acculturation correlated with appearance satisfaction, but not weight satisfaction. After accounting for BMI and social desirability, higher heritage acculturation and lower mainstream acculturation were associated with lower perceived pressure from media. Thus, heritage acculturation across religious denominations may serve as a buffer against appearance dissatisfaction and perceived media pressure. Manner of dress among the Muslim subgroup and its relation to religiosity and acculturation were also assessed. Muslim women who dressed in greater accordance with Islamic principles reported lower heritage acculturation and greater religiosity. Thus, Muslim women's manner of dress was related to their religiosity and the extent to which they embraced cultural values. These findings are discussed in terms of the possible distinctions between heritage acculturation and religiosity.

Body dissatisfaction and disordered eating among Portuguese and Spanish adolescents: The role of individual characteristics and internalisation of sociocultural ideals

The aim of this study was to explore the differences in patterns of risk factors for body dissatisfaction and disordered eating attitudes in both female and male adolescents from Portugal and Spain. The sample included 455 adolescents aged 12-16 years (M = 13.28, SD = 0.65) from two urban areas of each country. Body mass index, self-reported self-esteem, perfectionism, internalisation of sociocultural ideals, body dissatisfaction and disordered eating attitudes were assessed. Path analyses provided partial support for a cross-cultural model of body dissatisfaction and disordered eating in Western countries due to the presence of certain differences in the patterns of relationships across sex and country. The findings suggest the importance not only of identifying cultural specificities, even in "neighbouring" countries, but also of developing a global and comprehensive preventive approach that focuses on the influence of the ideal of beauty transmitted by Western societies.

Disordered eating behaviors in university students in Hanoi, Vietnam

BACKGROUND

The aim of the study was to examine disordered eating behaviors in university students in Vietnam.

METHODS

A total of 244 female university students participated, and 203 data could be analyzed. The Body Mass Index, the SCOFF screening questionnaire and the Eating Disorder Inventory 2 were used to explore disordered eating behaviors.

RESULTS

45.3% of the participants were underweight, 53.2% were normal weight and 1.5% were overweight. 48.8% of students reported two or more yes-responses on the SCOFF screening questionnaire which indicates a high possibility of having eating disorder symptoms. The mean score for underweight subjects (M = 14.79, SD = 6.81) indicated a lower level on the drive for thinness scale of the EDI-2 compared to normal weight subjects (M = 24.65, SD = 6.86) and overweight subjects (M = 31.33, SD = 6.66). Additionally, underweight subjects (M = 27.24, SD = 7.57) were less dissatisfied with their body than normal weight subjects (M = 35.94, SD = 8.67) and overweight subjects (M = 43.33, SD = 11.24). A significant positive correlation appeared between the BMI and the EDI-2. The SCOFF questionnaire showed a statistically significant negative correlation with the BMI and the EDI-2.

CONCLUSIONS

Despite some limitations the current study shows a tendency in young females in urban Vietnam to be underweight and to develop disordered eating symptoms such as drive for thinness and body dissatisfaction. However, more studies using the SCOFF and the EDI-2 would be needed to verify these findings.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

OBJECTIVES

This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014.

METHODS

The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified.

RESULTS

In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice.

CONCLUSIONS

Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management.

EXPERT REVIEWERS

Associate Professor Susan Byrne, Dr Angelica Claudino, Dr Anthea Fursland, Associate Professor Jennifer Gaudiani, Dr Susan Hart, Ms Gabriella Heruc, Associate Professor Michael Kohn, Dr Rick Kausman, Dr Sarah Maguire, Ms Peta Marks, Professor Janet Treasure and Mr Andrew Wallis.

The myth of Chinese Barbies: eating disorders in China including Hong Kong

Much of the literature on eating disorders deals with Western subjects. Although the majority of those seen in clinical settings are Caucasians, reports from Asia suggest that anorexia nervosa and bulimia nervosa do occur in the Chinese, sparking debate as to whether or not it is the result of Westernization. This project begins with a review of the current literature on eating disorders in Chinese populations and the role of culture as a mediating factor. A psychodynamic conceptualization and the potential role of traumatic experiences are explored in the emergence of pathological eating habits. Research suggests that applying Western models for Chinese subjects with eating disorders may not always be appropriate.

Body image concerns in obese women seeking bariatric surgery

Purpose

– The purpose of this paper is to assess multidimensional body image concerns in a sample of obese women seeking bariatric surgery at an outpatient hospital clinic in Hamilton, Ontario, Canada.

Design/methodology/approach

– A sample of obese adult women seeking bariatric surgery at an outpatient medical clinic in Hamilton, Ontario, Canada (n=148) completed various self-report measures of body image concerns, including body image dysphoria, body image quality of life, body image investment, and appearance satisfaction. Participant scores were compared to normative data. Correlations between body image concern measures and body mass index (BMI) were examined.

Findings

– Participants endorsed more body image dysphoria, more negative body image quality of life, and less appearance satisfaction than normative samples. BMI was not correlated with body image concern scores.

Practical implications

– Interventions aimed at reducing body image disturbance in obese women should target multiple components of body image concern. Decisions about who should receive interventions should not be based on BMI status.

Originality/value

– The majority of research on body image concerns focuses exclusively on evaluative constructs such as body image dissatisfaction. The current study examined affective, cognitive, and behavioural body image constructs. A better understanding of the multidimensional nature of body image concerns in obese women seeking bariatric surgery informs the development of effective, targeted interventions.

Illusory changes in body size modulate body satisfaction in a way that is related to non-clinical eating disorder psychopathology

Historically, body size overestimation has been linked to abnormal levels of body dissatisfaction found in eating disorders. However, recently this relationship has been called into question. Indeed, despite a link between how we perceive and how we feel about our body seeming intuitive, until now lack of an experimental method to manipulate body size has meant that a causal link, even in healthy participants, has remained elusive. Recent developments in body perception research demonstrate that the perceptual experience of the body can be readily manipulated using multisensory illusions. The current study exploits such illusions to modulate perceived body size in an attempt to influence body satisfaction. Participants were presented with stereoscopic video images of slimmer and wider mannequin bodies viewed through head-mounted displays from first person perspective. Illusory ownership was induced by synchronously stroking the seen mannequin body with the unseen real body. Pre and post-illusion affective and perceptual measures captured changes in perceived body size and body satisfaction. Illusory ownership of a slimmer body resulted in participants perceiving their actual body as slimmer and giving higher ratings of body satisfaction demonstrating a direct link between perceptual and affective body representations. Change in body satisfaction following illusory ownership of a wider body, however, was related to degree of (non-clinical) eating disorder psychopathology, which can be linked to fluctuating body representations found in clinical samples. The results suggest that body perception is linked to body satisfaction and may be of importance for eating disorder symptomology.