Conceptualizing body dissatisfaction in eating disorders within a self-discrepancy framework: a review of evidence

Beyond the surface: Understanding obsessive symptoms and body perceptions, from shape concerns to fear of blushing

INTRODUCTION

Recent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors).

METHODS

Psychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness.

RESULTS

The sample (N = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUTB). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUTB.

CONCLUSION

This study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.

Shape discrepancy, weight bias internalization, and eating-disorder psychopathology in patients with loss-of-control eating after bariatric surgery

BACKGROUND

Postoperative loss-of-control (LOC) eating is associated with eating-disorder psychopathology, poorer weight loss, and mental health outcomes following bariatric surgery. The nature and significance of shape discrepancy has not been examined in patients with LOC eating following bariatric surgery.

OBJECTIVES

To examine shape discrepancy, WBI (weight bias internalization) and ED (eating-disorder) psychopathology in patients with LOC eating after bariatric surgery.

SETTING

Yale University School of Medicine, United States.

METHODS

Participants (N = 148, 84.5% female) seeking treatment for eating and weight concerns and with recurrent LOC eating approximately 6 months after bariatric surgery were assessed with the Eating Disorder Examination-Bariatric Surgery Version Interview and completed questionnaires measuring WBI and depression. Participants selected body shapes representing their current and ideal shapes, and a shape discrepancy score was calculated.

RESULTS

Most participants (N = 142/148) reported an ideal shape smaller than their current shape; shape discrepancy scores ranged from 0 to 5 (M = 1.89, SD = .82). Greater shape discrepancy was significantly correlated with greater current body mass index (BMI; r = .271, p=<.001) and percent weight loss (%WL) since surgery (r = -.19, p = .023). After adjusting for %WL, shape discrepancy was significantly correlated with greater WBI (r = .37, p < .001), depression (r = .27, p < .001), and ED psychopathology (r = .25, p = .002).

CONCLUSIONS

Nearly all participants preferred a significantly smaller shape than their current shape. Greater discrepancy between current and ideal shape was associated with higher levels of a range of behavioral (ED psychopathology), cognitive (WBI), and psychological/somatic (depression) concerns. These findings, which persisted after adjusting for %WL, highlight the importance of addressing body image in postoperative interventions.

Analysis of the Effectiveness of an Affective-Sexual Education Program for Adults with Intellectual Disabilities

In recent years, the number of programs to improve sex education for people with intellectual disabilities has increased. However, in most cases, these programs do not provide any evidence of their impact. In the present study we analyzed the effectiveness of the SALUDIVERSEX affective-sexual education program for people with intellectual disabilities using a controlled trial design. 246 individuals from eastern Spain completed a battery of questionnaires before and after the intervention. Multilevel statistical analyses showed that the risk of experiencing sexual abuse had significantly decreased and knowledge about sexuality significantly increased among those who received the intervention compared to those who did not. The evaluation of the professionals who worked daily with the participants agreed on how knowledge about sexuality and intimacy increased and concerns about sexuality decreased among those in the intervention group. The SALUDIVERSEX program is a powerful educational strategy to promote better sexual health and quality of life for people with intellectual disabilities.

"Eat more protein, build more muscle": A grounded theory study of muscle-building behaviors among Canadian adolescents and young adults

Unique risk factors for the development of muscle dissatisfaction and engagement in muscle-building behaviors have been described by theoretical frameworks and supported by empirical research. What remains unknown are the unique processes, including catalysts and facilitators, which underpin engagement in muscle-building behaviors. Therefore, this study used a grounded theory methodology to elucidate the process of engagement in muscle-building behaviors. Thirty-three individual semi-structured interviews with Canadian adolescents and young adults ages 16-30 years were conducted. Transcripts were analyzed using initial and focused coding to identify themes that explained the grounded theory. The core theme underpinning the grounded theory was balancing aesthetic, health, and functional goals in relation to participants' engagement in muscle-building behaviors. Participants described experiences that encompassed several unique phases of muscle-building engagement, including the initiation phase, beginner phase, preservation phase, and intensification phase. Participants also described unique methods of gathering information on muscle-building behaviors, and their own analysis and decision-making processes driving their behaviors. Findings from this study extend prior theory and research by conceptualizing a novel process theory of engagement in muscle-building behaviors among adolescent and young adults, resulting in important implications for research and practice.

Body-related self-conscious emotions, self-compassion, and dietary restraint in Canadian undergraduate university students: A multilevel mediation and moderation analysis

OBJECTIVE

Self-compassion has an inverse association with dietary restraint however, the mechanisms linking self-compassion and dietary restraint are not clear. This study aimed to determine to what extent self-compassion was inversely concurrently related to dietary restraint, indirectly through body-related self-conscious emotions, and to what extent trait self-compassion moderated the concurrent within-person association between body-related self-conscious emotions and dietary restraint.

METHOD

Data was collected from 224 Canadian university students who reported on trait self-compassion at baseline and body-related shame, guilt, envy, and embarrassment, and dietary restraint biweekly between November 2020 and August 2021.

RESULTS

Results from a 2-1-1 multilevel mediation model showed that trait self-compassion was indirectly concurrently related to dietary restraint through body-related shame, guilt, envy, and embarrassment. Results from the moderation model showed that there was a significant positive concurrent within-person association between body-related shame, envy, and embarrassment, but not guilt, with dietary restraint. These relationships were not moderated by trait self-compassion.

DISCUSSION

This study adds to our understanding of the concurrent association between body-related self-conscious emotions and dietary restraint, and the mechanisms through which self-compassion is related to dietary restraint. Given body-related self-conscious emotions were related to dietary restraint at both the within-person and between-person level, both compassion-focused interventions that aim to improve general levels of body-related self-conscious emotions and interventions that aim to overcome spikes in these emotions compared with one's usual level are warranted.

PUBLIC SIGNIFICANCE STATEMENT

Negative body-related self-conscious emotions were related to higher levels of dietary restraint both across individuals and within individuals over time; and may play a mechanistic role in linking self-compassion with dietary restraint. Interventions aimed at reducing negative body-related self-conscious emotions are warranted in the prevention of eating disorder psychopathology.

Validation of an Arabic version of the eating disorder inventory's body dissatisfaction subscale among adolescents, adults, and pregnant women

INTRODUCTION

The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-oriented body dissatisfaction in research and clinical practice. However, no validated Arabic version of this scale exists to date. In this study, we sought to validate this instrument in three samples of native Arabic-speaking adolescents, adults, and pregnant women from Lebanon.

METHODS

A total of 826 adults, 555 adolescents, and 433 pregnant women were included. To examine the factor structure of the BDS, we performed an exploratory factor analysis (EFA), using a principal component analysis via the FACTOR software on the first split-half subsample among Lebanese adults. We used data from the second split-half in the adult sample to conduct a Confirmatory Factor Analysis (CFA) through the SPSS AMOS v.29 software. That verified model was tested via CFA on adolescents and pregnant women.

RESULTS

The EFA showed a bidimensional structure for the BDS, with all 9 items retained and divided into Factor 1 = Body Satisfaction (negatively-worded items) and Factor 2 = Body Dissatisfaction (positively-worded items). The CFA demonstrated invariable goodness-of-fit of the instrument in the three studied populations. McDonald's omega values were also adequate in the three samples, demonstrating its reliability. Moreover, the BDS showed invariance across sex among both adolescents and adults. Finally, higher BDS scores were correlated with more disordered eating, less body appreciation and less functionality appreciation, thus attesting to convergent validity of the scale. In addition, BDS scores correlated positively with depression and anxiety scores, indicating adequate patterns of divergent validity.

CONCLUSION

In light of our findings, we endorse the use of the BDS by healthcare professionals in Arabic-speaking countries, in order to assess thinness-oriented body dissatisfaction in an appropriate and timely manner and ease early referral to a specialist, thereby preventing the deleterious health-related risks associated with this condition.

A network analysis of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults

OBJECTIVE

Previous studies have revealed associations between disordered eating symptoms, big-five personality traits, and psychological distress. However, limited research has explored these relationships as a network, including their interconnections, and even less has done so in non-Western populations. We employed network analysis to investigate the co-occurrence of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults.

METHOD

A sample of 500 Chinese adults (256 men) completed measures assessing big-five personality traits, psychological distress, and disordered eating symptoms. The network of personality traits, psychological distress, and disordered eating symptoms was estimated, including its central and bridge nodes.

RESULTS

The central nodes in the network were the facets of openness (like adventure), extraversion (like going to social and recreational parties), and disordered eating symptoms (dissatisfaction with body weight or shape). Moreover, certain facets of neuroticism (always worrying something bad will happen), psychological distress (feeling worthless), and an inverse facet of extraversion (bored by parties with lots of people) were identified as essential bridge nodes in maintaining the structure of the network.

CONCLUSION

Our findings suggest that personality traits (e.g., openness and extraversion) and body dissatisfaction are important in maintaining the network in a community sample of Chinese adults. While future replication is needed, findings from this study suggest that individuals with negative self-thinking, predisposed neuroticism, and extraversion may be at risk of developing disordered eating symptoms.

PUBLIC SIGNIFICANCE

The present study contributes to existing knowledge by employing a network perspective to examine the associations between disordered eating symptoms, big-five personality traits, and psychological distress in a Chinese adult community sample. The identified facets of neuroticism and extraversion and symptoms of psychological distress may be worthy of targeting in the prevention and treatment of disordered eating in the Chinese context.

Screen use while eating is associated with lower intuitive eating and higher disordered eating in Chinese adult men and women

OBJECTIVE

We aimed to explore the potential associations between screen use while eating and intuitive eating and disordered (thinness-oriented and muscularity-oriented) eating behaviors.

METHODS

Analyses included 600 Chinese adults (50% women; Mage  = 30.67, SD = 8.08) recruited online. The use of four major screen devices was captured, including cell phones, tablets, computers, and TVs. Three types of eating behaviors were examined, namely intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating. Pearson correlation and hierarchical regression analyses were conducted separately for men and women to examine the sex-specific associations between screen use while eating and intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating.

RESULTS

In both men and women, more screen use while eating was significantly associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating, above and beyond total screen time and social media use.

DISCUSSION

We found preliminary evidence for the significant links between screen use while eating and intuitive eating and disordered eating. Given the global increases in screen use, continued research is warranted to further explore the role of screen use while eating in the development and maintenance of intuitive eating and disordered eating.

PUBLIC SIGNIFICANCE

Much remains unknown regarding screen use while eating and eating behaviors. We found that in both Chinese men and women, more screen use while eating was significantly and uniquely associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating. Findings highlight the importance of incorporating screen use while eating in future research on intuitive eating and disordered eating.

Body Dissatisfaction and Restricted Diet in Chinese Adolescents: A Longitudinal Analysis

Background/Objective

Body dissatisfaction and restricted diet frequently co-occur among adolescents. However, the exact temporal relationship between the two is unclear. Furthermore, most relevant studies concentrate on Western cultural backgrounds, with only a few investigations conducted in many non-Western developing countries, including China. Therefore, this study aimed to investigate the mutual relationship between body dissatisfaction and restricted diet among Chinese adolescents.

Patients/Methods

We recruited a sample of 672 middle school students from China (358 females, mean age = 14.33±0.94) and collected self-reported measures of body dissatisfaction and restricted diet at three-time points (with a five-month interval between each). We used cross-lagged models to examine the bidirectional relationship between body dissatisfaction and restricted diet.

Results

(1) Both cross-sectional and cross-lagged correlation analysis showed positive correlation between body dissatisfaction and restricted diet (r=0.29-0.36; r=0.25-0.35, Ps<0.001); (2) The cross-lagged effect of body dissatisfaction on restricted diet was significant (β=0.09, 0.13, Ps<0.01), and vice versa (β=0.20, 0.18, Ps<0.001); (3) The differences in the associations between body dissatisfaction and restricted diet across gender were found.

Conclusion/Implications

There is a bidirectional relationship between adolescents' body dissatisfaction and restricted diet. Our findings enrich the existing literature on body image and dietary health, thereby contributing to the reduction of negative body image and disordered eating among adolescents.

Weight status is associated with clinical characteristics among individuals with bulimia nervosa

Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25; N = 32), group with overweight (OW-BN; BMI ≥25 and <30; N = 66), and group with obesity (O-BN; BMI ≥30; N = 54). We compared the groups on demographics, diet and weight histories, body esteem, BN symptoms, and depression using chi square, analysis of variance, analysis of covariance, and Poisson regression models. The O-BN group was older (d = 0.57) and OW-BN and O-BN groups had greater proportions of race/ethnic minorities than NOW-BN group. The O-BN group was significantly younger at first diet (d = 0.41) and demonstrated significantly higher cognitive dietary restraint (d = 0.31). Compared to NOW-BN, O-BN participants had lower incidence of objective binge eating (incidence rate ratio [IRR] = 4.86) and driven exercise (IRR = 7.13), and greater incidence of vomiting (IRR = 9.30), laxative misuse (IRR = 4.01), and diuretic misuse (d = 2.08). O-BN participants also experienced higher shape (d = 0.41) and weight (d = 0.42) concerns than NOW-BN and OW-BN, although NOW-BN experienced higher shape (d = 0.44) and weight (d = 0.39) concerns than OW-BN. Groups did not differ on depression scores. These results were replicated when examining BMI as a continuous predictor across the full sample, with the exception of objective binge eating and driven exercise, which were not significantly associated with BMI. Individuals with BN and comorbid obesity have distinct clinical characteristics. Existing interventions may need to be adapted to meet clinical needs of these individuals.

Gender Expression, Weight Status, and Risk of Experiencing Eating Disorders among Gender-Diverse Adults Assigned Male at Birth in Bangkok, Thailand

This study examines the association between gender expression, weight status, and the risk of experiencing eating disorders among gender-diverse adults assigned male at birth living in Bangkok, Thailand. Participants completed self-administered questionnaires to provide demographic data and anthropometric measures, and an Eating Attitude Test-26 (EAT-26) to determine the risk of experiencing eating disorders. The associations between gender expression, weight status, and the risk of experiencing eating disorders were analyzed using multivariable logistic regression models. No significant differences were observed in weight-related variables based on gender expression. Participants self-described as feminine/androgynous had lower odds of experiencing a high risk of eating disorders compared to those self-described as masculine (odds ratio (OR) = 0.49; 95% confidence interval (95% CI) = 0.27, 0.88). A higher body mass index (BMI) (OR = 1.07; 95% CI = 1.01, 1.14) and BMI discrepancy (OR = 1.13; 95% CI = 1.03, 1.24) were associated with higher odds of engaging in extreme weight-control behaviors. The risk of experiencing eating disorders among Thai gender-diverse adults assigned male at birth could differ across gender expression and weight status. Further research is needed to expand the understanding of these relationships and develop tailored intervention programs to mitigate the risk.

Emotional regulation and body dissatisfaction: the mediating role of anger in young adult women

Introduction

Emotion regulation difficulties have an important role in the presence of negative self-image. These problems in the self-regulation of emotion could lead to negative emotional processes (such as anger) that can lead to body dissatisfaction. Therefore, the aim of the present study was to examine emotion regulation difficulties than can negatively impact self-image and to understand if anger acts as mediator in the relationship between emotion regulation and body dissatisfaction.

Methods

A cross-sectional study was carried out comprising 565 young adult women aged 18-30 years. The participants were administered the Difficulties in Emotion Regulation Scale (DERS), the State-Trait Anger Expression Inventory 2 (STAXI-2), and the Body Dissatisfaction dimension of the Eating Disorder Inventory-2 (EDI-2). The proposed hypotheses were tested by path analysis in MPlus 8.0.

Results

The results indicated that anger had a positive significant effect on body dissatisfaction as well as the non-acceptance of emotional responses, the lack of emotional awareness, and the lack of emotional clarity. Of all the dimensions of emotional regulation difficulties, impulse control difficulty was the dimension which had a positive significant indirect effect on body dissatisfaction explained by increased anger.

Discussion

The present study suggests the importance of emotion regulation in the prevention of body dissatisfaction. Impulse control difficulty may be the key emotion regulation emotion in explaining the increments of anger that lead to body dissatisfaction. Among young adults, the promotion of positive body image can be promoted by helping this population to self-regulate their anger impulses.

Transition Regret and Detransition: Meanings and Uncertainties

Gender transition is undertaken to improve the well-being of people suffering from gender dysphoria. However, some have argued that the evidence supporting medical interventions for gender transition (e.g., hormonal therapies and surgery) is weak and inconclusive, and an increasing number of people have come forward recently to share their experiences of transition regret and detransition. In this essay, I discuss emerging clinical and research issues related to transition regret and detransition with the aim of arming clinicians with the latest information so they can support patients navigating the challenges of regret and detransition. I begin by describing recent changes in the epidemiology of gender dysphoria, conceptualization of transgender identification, and models of care. I then discuss the potential impact of these changes on regret and detransition; the prevalence of desistance, regret, and detransition; reasons for detransition; and medical and mental healthcare needs of detransitioners. Although recent data have shed light on a complex range of experiences that lead people to detransition, research remains very much in its infancy. Little is known about the medical and mental healthcare needs of these patients, and there is currently no guidance on best practices for clinicians involved in their care. Moreover, the term detransition can hold a wide array of possible meanings for transgender-identifying people, detransitioners, and researchers, leading to inconsistences in its usage. Moving forward, minimizing harm will require conducting robust research, challenging fundamental assumptions, scrutinizing of practice patterns, and embracing debate.

The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study

Background

Mental illness and obesity are among the biggest challenges to population health, they are linked, and may be modifiable during adolescence. We aimed to determine intervening pathways between mental health and BMI z-score symptoms across adolescence.

Methods

In this longitudinal cohort study, we used path models to examine self-reported dieting, happiness with appearance, self-esteem and bullying at 14 years as potential mediators of the cross-lagged relationship between mental health (via the Strengths and Difficulties Questionnaire) and Body Mass Index (BMI) z-score at 11 and 17 years by sex in the UK Millennium Cohort Study, a prospective cohort study of 18,818 children born in the UK between September 1st, 2000, and January 31st, 2002. Full, incomplete data on all singleton children still participating in the study by age 11 years were analysed in GSEM via maximum likelihood estimation (N = 12,450).

Findings

We found happiness with appearance and self-esteem, but not dieting or bullying, mediated the relationship between BMI age 11 and mental health age 17. Each increase in BMI z-score at 11 years was associated with 0.12 increase for boys and a 0.19 increase for girls in scores of unhappiness with appearance (boys: b 0.12, 95% C.I.; girls b 0.19, C.I. 0.14 to 0.23) and a 16% increase for boys and a 22% increase for girls in odds of low self-esteem (boys OR 1.16, 95% C.I. 1.07 to 1.26; girls: OR 1.22, 95% C.I. 1.15 to 1.30) at 14 years. In turn, for both boys and girls, being unhappy with appearance and low self-esteem at 14 years were associated with a greater likelihood of emotional and externalizing symptoms at 17 years.

Interpretation

Early prevention strategies to encourage healthy physical and mental development of children need to focus on the promotion of positive body-mage and self-esteem.

Funding

The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR).

Does suppressing weight improve body satisfaction? A longitudinal analysis in undergraduate men and women

Young adults with high body dissatisfaction may engage in disordered eating to reduce their weight, believing that weight loss will improve body satisfaction. Yet, limited research has examined whether suppressing weight contributes to improved body satisfaction in nonclinical samples. Undergraduate students (N = 661; 81.2% female) completed three surveys over a six-month period. Longitudinal mixed-effect models investigated whether weight suppression was associated with change in body dissatisfaction. Body dissatisfaction was higher on average among women, and greater weight suppression was associated with greater body dissatisfaction across genders. Among women, higher baseline weight suppression was related to higher body dissatisfaction across time; however, neither baseline weight suppression nor change in weight suppression were associated with change in body dissatisfaction. Among men, higher baseline weight suppression was related to increased body dissatisfaction over time. However, greater increases in weight suppression were associated with improvements in body dissatisfaction. Thus, the impact of weight suppression on body image outcomes may differ by gender. Findings suggest that when men become more weight suppressed, their body dissatisfaction decreases; however, changes in weight may not impact body dissatisfaction in women. Findings may inform educational programs challenging diet and weight loss myths, particularly for women.

Association between Motivation in Physical Education and Positive Body Image: Mediating and Moderating Effects of Physical Activity Habits

Concerns about body image might prevent adolescents from participating in physical education (PE) classes and physical activities during leisure-time. In this cross-sectional study, we assessed the relationships between teacher support of autonomy, student motivations for PE, and positive body image, in a sample of Lithuanian adolescents. A total of 715 adolescents (51.89% girls) participated in the study. Ages ranged from 14 to 18 years, with a mean age of 16.00 (SD = 0.79) for girls and 15.99 (SD = 0.75) for boys. The questionnaire consisted of demographic questions, the Learning Climate Questionnaire, the Revised Perceived Locus of Causality in Physical Education Questionnaire, the Body Appreciation Scale-2, the Self-Report Habit Index for Physical Activity (PA), perceived physical fitness (PPF), and Godin Leisure-Time Exercise Questionnaire. The results showed that teacher support for students' autonomy was associated with higher positive body image. In adolescent girls, autonomous motivation for PE was the mediator between teacher support of autonomy and positive body image. The associations between self-determined motivation in PE and positive body image were mediated by PPF on one hand, and through PA habits and PPF on the other hand of the structural equation model (in girls). PA habits moderated associations between PE motivation and PPF. Associations between PE motivation and PPF were stronger in girls with the lowest PA habits compared to girls with mean PA habits. These results suggest that PE classes are important for promoting students' positive body images. PE teachers are advised to use pedagogical strategies that promote the self-determined motivation of students for PE. Increased self-determined motivation for physical education might be an effective strategy for physical self-perception and positive body image promotion in adolescent girls, especially those with low PA habits.

Images of bodies in mass and social media and body dissatisfaction: The role of internalization and self-discrepancy

Introduction

The study examines the influence on body dissatisfaction of viewed images of bodies transmitted over mass media and social media, as mediated by the internalization of body ideals through media and self-discrepancy (the difference between the perceived actual self and the perceived ideal self).

Method

In this study, the images of bodies individuals view in their everyday media diet are estimated using a newly developed pictorial scale for women (thinness) and men (muscularity). For participants, the perceived body image is formed through mass media (magazines, TV) and social media (Facebook, YouTube, Instagram, and Snapchat). The self-discrepancy theory is then used to explain the effect of images of bodies in the media on the internalization of these body ideals and body dissatisfaction.

Results

Results show that Facebook and YouTube shape body ideals perceived to be prevalent in the media, negatively influencing internalization and self-discrepancy. Self-discrepancy, in turn, increases body dissatisfaction. However, for males, the perceived body ideals in the media did not affect body dissatisfaction, internalization, or self-discrepancy.

Discussion

These results emphasize the importance of combining and comparing mass and social media and differentiating between female and male concerns regarding body image.

Childhood trauma and body dissatisfaction among young adult women: the mediating role of self-criticism

The present study examined the relationship between childhood trauma and body dissatisfaction among young women. The mechanisms through which childhood trauma are related to body dissatisfaction have not been sufficiently examined previously. The aims of the present study were to analyze the (i) relationships between childhood trauma, self-criticism, and body dissatisfaction and (ii) mediating role of self-criticism in the relationship between childhood trauma and body dissatisfaction. A total of 754 young adult women aged 18 to 30 years participated (M = 20.49 years; SD = 2.28). The findings showed positive correlations between childhood trauma, self-criticism, and body dissatisfaction. The mediation model indicated that (i) greater childhood trauma was associated with greater self-criticism, and (ii) greater self-criticism was significantly associated with greater body dissatisfaction. Therefore, childhood trauma was indirectly associated with increased body dissatisfaction and explained by the positive relationship with increased self-criticism. These results highlight the importance of childhood trauma in body dissatisfaction among young adult women and demonstrates self-criticism coping style as a key factor in this relationship. Early detection of self-criticism-based coping styles and childhood trauma could improve (i) quality of life and prevent the onset of body dissatisfaction, and (ii) treatment planning and prevent body dissatisfaction from escalating into major problems (e.g., eating disorders, body dysmorphic disorder, morbid exercise and/or depressive symptomatology).

RISK OF EATING DISORDERS AND BODY DISSATISFACTION AMONG GYM-GOERS IN ANKARA, TURKEY

ABSTRACT Introduction: Although regular exercise is widely recommended to promote optimal health, it is thought that gym-goers are at risk for body dissatisfaction and eating disorders. Objective: This study assessed the risk of eating disorders and the prevalence of body dissatisfaction in gym-goers enrolled in a gym located in the city of Ankara, the capital of Turkey. Methods: This cross-sectional study was conducted with 206 gym-goers, 102 males (mean age of 25.8±7.86 years) and 104 females (mean age of 26.5±9.07 years), who regularly exercised at least twice a week at this gym during the years 2018 to 2019. Demographic characteristics and exercise status of the participants were collected through face-to-face interviews via a questionnaire form. The REZZY (SCOFF) questionnaire was administered to determine the risk of eating disorders and the Stunkard Figure Rating Scale was administered to determine body dissatisfaction. Results: The mean REZZY score in females (1.4±1.21) was higher than in males (0.8 ± 1.05) (p<0.01). In males, 26 out of 102 (25.5%) had a score indicating a risk of eating disorders. In females, 44 out of 104 (42.3%) had a score indicating a risk of eating disorders. The risk of eating disorders is higher in females than in males (p<0.05). While 49.0% of males stated that their current body size is greater than the ideal body size, 76.0% of females said that their current body size is greater than the ideal body size. Conclusion: Consequently, it was determined that gym-goers were a risk group in terms of eating disorders and body dissatisfaction. Level of Evidence: III; Cross-sectional study.

The Effect of Self-Discrepancy on Online Behavior: A Literature Review

People will experience self-discrepancy when they perceive their actual self is distanced from their ideal self and ought self. The perceived self-discrepancy has a significant impact on people's online behavior. The goal of this paper is to provide an overview of the research on self-discrepancy in the Internet era through a literature review. A total of 37 papers were included in this review. First, this study presents the basic characteristic of the reviewed articles (such as research contexts, samples, and data collection methods). Second, it summarized how the Internet affected people's self-discrepancy. Third, this review identified how self-discrepancy was associated with different kinds of online behavior (such as impression management, knowledge contribution, and gaming addiction). Finally, this study outlined several possible directions for future research.

Sexual Self-Concept Discrepancies Mediate the Relation between Gender Dysphoria Sexual Esteem and Sexual Attitudes in Binary Transgender Individuals

Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals' sexual esteem and sexual attitudes.

The effect of temperament and character on body dissatisfaction in women with bulimia nervosa: The role of low self‐esteem and depression

Objective

Method

Results

Conclusions

Low self‐esteem and depression were examined as mediators of associations between temperament and character dimensions and body dissatisfaction in women with bulimia nervosa.

Harm avoidance contributed significantly to body dissatisfaction.

The association between harm avoidance and body dissatisfaction was mediated by low self‐esteem alone and depression and low self‐esteem in serial.

Motivation to consume palatable foods as a predictor of body image dissatisfaction: Using the Power of Food Scale in a Brazilian sample

The Power of Food Scale (PFS) is a questionnaire for self-assessing the motivation to consume palatable foods, especially in environments where food is abundant and constantly available. This study aimed to a) assess the factorial structure of the PFS in a Brazilian sample and b) examine the relationship between the power of food and body image dissatisfaction and BMI. The PFS and Body Shape Questionnaire (BSQ) were applied to a sample of 300 adults. Data were analysed using confirmatory factor analysis. Composite reliability (CR) was used to verify factor reliability. A partial least squares structural equation model was used to verify the effect of the PFS score on body image dissatisfaction. The PFS had an adequate factorial structure in this Brazilian sample, showing three well-defined factors: food available (CR = 0.91), food tasted (CR = 0.84), and food present (CR = 0.87). The BSQ showed one reliable factor (CR = 0.97). The power of the food aggregate factor significantly predicted body mass index (β = 0.16; p = .01) and body image dissatisfaction (β = 0.46; p < .001). The effect size was small for body mass index (f² = 0.02) and medium for body image dissatisfaction (f² = 0.26). The food present factor also had a slightly higher average among the three PFS factors. Women had higher PFS scores than men. Understanding the role that this motivation plays in physical and psychological outcomes such as body dissatisfaction can contribute to developing treatment strategies and support health professionals' performance in clinical settings.

Body Dissatisfaction and Disordered Eating Behaviors: The Mediation Role of Smartphone Addiction and Depression

This study aimed to determine whether smartphone addiction and depression sequentially mediate the relationship between body dissatisfaction and disordered eating behaviors (e.g., restrained eating, emotional eating and external eating). A total of 5986 participants (54.1% females, average age = 19.8 years, age range = 17–32) completed the Satisfaction and Dissatisfaction with Body Parts Scale, the Three-Factor Eating Questionnaire, the Smartphone Addiction Scale and the Patient Health Questionnaire-9. Mediational analysis showed that, after controlling for age, sex and body mass index, body dissatisfaction was related to disordered eating behaviors through (a) the mediating effect of smartphone addiction, (b) the mediating effect of depression, and (c) the serial mediating effect of smartphone addiction and depression. In conclusion, our study showed for the first time that smartphone addiction and depression can be sequential mediator variables in the association between body dissatisfaction and disordered eating. However, this study is a cross-sectional study; future longitudinal studies could further test the causal associations between these study variables.

The Association of Body Image Self-Discrepancy With Female Gender, Calorie-Restricted Diet, and Psychological Symptoms Among Healthy Junior High School Students in Japan

Background: Body image self-discrepancy reflects a preference for weight loss regardless of normal body size and is a distorted cognition that may be a precursor to eating disorders. The aim of this study was to investigate factors associated with body image self-discrepancy among healthy junior high school students in Japan.

Method: This cross-sectional study was conducted at one junior high school in Saitama, Japan, in December 2016. After excluding obese participants (defined as 20% above their ideal weight), 304 students (mean age, 13.9years; n=181 girls, 59.5%) who fell into underweight (n=22, 7.2%) and normal weight categories were selected. Body image self-discrepancy was measured using the Contour Drawing Rating Scale which includes eight separate figures representing body sizes. We then calculated the difference by subtracting ideal from current body sizes and defined body image self-discrepancy if the difference >1.

Results: Girls constituted 92% (n=49) of the 53 students with body image self-discrepancy. In all students, multivariable stepwise models demonstrated that female gender (OR, 6.92, 95% CI: 2.33–20.51), a calorie-restricted diet (OR, 5.18, 95% CI: 2.22–12.05), and psychological symptoms (OR, 1.47, 95% CI: 1.15–1.87) were significantly associated with an increased risk of body image self-discrepancy. Specifically for girls, an increased risk of body image self-discrepancy was associated with calorie-restricted suppers and psychological symptoms.

Conclusion: Body image self-discrepancy among healthy adolescents in Japan was found to be closely linked to being a girl, having a calorie-restricted diet, and having psychological symptoms.

Are marked body shape concerns associated with poorer outcomes at the one-year follow-up in anorexia nervosa?

OBJECTIVE

Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients' clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up.

METHOD

Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ).

RESULTS

Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS "total score"). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life.

DISCUSSION

The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course.

Relationships between nonappearance self-discrepancy, weight discrepancy, and binge eating disorder symptoms

PURPOSE

Self-discrepancy (i.e., perceived differences between one's actual self and personal standards) has been associated with binge eating disorder (BED) symptoms. However, little is known about how weight discrepancy (i.e., the difference between one's actual and ideal weights) interacts with or is distinguished from nonappearance self-discrepancy (discrepancy unrelated to weight or shape) in predicting BED severity. The current study examined how these two forms of discrepancy independently and interactively relate to BED and associated symptoms to elucidate how facets of self-discrepancy may operate to precipitate and maintain BED.

METHODS

Adults with BED (N = 111) completed questionnaires and interviews prior to treatment that assessed self-discrepancy (computerized selves) and weight discrepancy (assessed during the Eating Disorder Examination [EDE]) as predictors of global eating disorder (ED) symptomatology (EDE Global score), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg Self-Esteem Scale), and ED-related impairment (Clinical Impairment Assessment).

RESULTS

Multivariate regression models indicated nonappearance self-discrepancy and weight discrepancy were not significantly related to the severity of global ED symptoms, but both independently predicted impairment (ps < 0.05). Nonappearance self-discrepancy, but not weight discrepancy, was also associated with higher depression (p = 0.001), anxiety (p < 0.001), and lower self-esteem (p < 0.001).

CONCLUSION

These findings suggest distinct associations of weight discrepancy and nonappearance self-discrepancy with ED and related symptoms, as well as each of these constructs' relevance to everyday functioning in BED. The results also highlight potential avenues for future research to examine mechanistic pathways by which self-discrepancy influences BED severity.

LEVEL OF EVIDENCE

V, descriptive cross-sectional study.

The relationship between premorbid intelligence and symptoms of severe anorexia nervosa restricting type

The purposes of this study were as follows: to compare premorbid IQ with present IQ in patients with more severe anorexia nervosa restricting type (AN-R) and to investigate the relationship between decreasing IQ and symptoms in patients with severe AN-R. Twenty-two participants were recruited (12 were AN-R patients; 10 were healthy controls). The average BMI in AN-R patients and healthy controls was 12.65 and 19.82, respectively. We assessed the outcomes using the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), the Japanese Adult Reading Test, The Eating Disorders Inventory-2 (EDI-2), Beck Depression Scale-2 (BDI-2) and State-Trait Anxiety Index. In two-way ANOVA, there were significant interactions for the FIQ and PIQ. Only in the AN-R group, a significant single main effect of time was evidenced for the FIQ and PIQ. In the AN-R group, a significantly high positive correlation was found between changes in the PIQ and the body dissatisfaction subscale of the EDI-2. These findings raise the possibility that in patients with severe AN-R, an excessive decrease in body weight induces decreased PIQ; as a result, they have worse dissatisfaction with their body shape.

Is the Effect of Body Dissatisfaction on Depressive Symptoms Dependent on Weight Status? A Study with Early-to-Middle Adolescents

Depression is a recognized mental health problem in adolescence and body dissatisfaction is an important risk factor. The main goal of this study is to examine the relationship between body dissatisfaction and depressive symptoms, and whether it depends on adolescents' weight status, an issue that remains understudied. Two hundred and fourteen adolescents (12-16 years) completed self-report measures of depressive symptoms, body dissatisfaction and weight status (i.e., current body weight and height, to compute body mass index z-scores, BMIz). Hierarchical multiple regression and moderation analyses were conducted, accounting for gender and age effects on depressive symptoms. Body dissatisfaction was found to be a predictor of depressive symptoms for the low and median BMIz adolescents, but not for those with high BMIz. In addition, this interaction of body dissatisfaction and BMIz improved the ability of the regression model to explain depressive symptoms´ variance beyond the effect of gender and age. The high-BMIz adolescents presented higher body dissatisfaction but similar levels of depressive symptoms, compared to the lower BMIz adolescents. These findings suggest the influence of body dissatisfaction in the emergence of depressive symptoms in the first half of adolescence, and the importance of weight status throughout this path.

Body composition parameters can better predict body size dissatisfaction than body mass index in children and adolescents

PURPOSE

Recent studies suggest that body mass index is not a reliable enough measurement for body composition in individuals, particularly in older and younger people. However, most research on body image has used the body mass index (BMI) as a physiological predictor of body satisfaction, particularly in children. The aim of this study was to investigate whether body composition is a better predictor of body size dissatisfaction in children than BMI.

METHODS

This is a cross-sectional study. Healthy children and adolescents aged 5-19 years, sex male and female, were recruited using a convenience sample in Brazil. BMI was measured according to the international standardization method and body composition was measured by bioelectrical impedance analysis (BIA) with a portable device model (BIA InBodyS10 multi-frequency, USA). Body size dissatisfaction was assessed using the Kakeshita's Figure Rating Scale for Brazilian Children. Data were analyzed with logistic regression analysis.

RESULTS

A total of 547 participants were evaluated, including 54% females and 67% Caucasian, with a mean age of 11.4 ± 3.8 years. The mean BMI was 20.5 ± 4.6 kg/m², and the mean percentages of fat and lean mass were 23.01 ± 10.59% and 72.84 ± 10.03%, respectively. In the multivariable model, only body composition was significantly associated with body size dissatisfaction (odds ratio: 1.849 (1.085-3.149, p = 0.024) and 1.828 (1.043-3.202, p = 0.035), respectively).

CONCLUSIONS

Body composition measures can better predict body size dissatisfaction in children and adolescents than BMI. This result may be relevant for the design of future studies on physiological indicators and body satisfaction.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Executive functioning and spatial processing in anorexia nervosa: an experimental study and its significance for the allocentric lock theory

PURPOSE

The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames-egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN).

METHODS

Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress.

RESULTS

AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients.

CONCLUSIONS

The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Examining the role of social physique anxiety on the relationship between physical appearance comparisons and disordered eating symptoms among Spanish emerging adults

The present study extends previous research by examining the moderating/mediating role of social physique anxiety (SPA) on the relationship between physical appearance comparisons (PAC) and symptoms of disordered eating (DE) in adolescent population. A total of 555 emerging adults (59% women) ranging from 18 to 30 years of age (M = 21.34, SD = 2.80) were recruited from two public universities from Spain using a non-probabilistic sampling technique. Participants completed a self-reported questionnaire comprising the variables of research interest. Once the effects of sex (i.e., being men or women), age, body mass index, and depressive symptoms were controlled for, the results from bootstrapping cross-sectional regression analyses supported both the moderating and mediating effect of SPA on the relationship between PAC and DE. Sex did not moderate any of these relationships. From these findings, it follows that incorporating strategies aimed at decreasing PAC and SPA may contribute to improved prevention efforts aimed at decreasing DE among Spanish emerging adults of both sexes.

Effects of acceptance and reappraisal on body dissatisfaction: an experimental comparison of two adaptive emotion regulation strategies

BACKGROUND

In recent years, research has increasingly focused on body dissatisfaction, which is associated with numerous negative psychological and physical health consequences and, more importantly, with the development and maintenance of eating pathology.

OBJECTIVE

In the present study, we focused on the effect of two adaptive emotion regulation strategies (acceptance and reappraisal) on body dissatisfaction compared to a control group, and pre- and post-induction of body dissatisfaction.

METHODS

A total of 105 women [mean age (M) = 22.07; standard deviation (SD) = 6.11] were randomly assigned to one of the two emotion regulation conditions: acceptance (n = 35) and reappraisal (n = 35) or to a control group (n = 35). Participants were instructed accordingly with the condition that was assigned (acceptance or reappraisal). Participants were then induced body dissatisfaction by exposure to images representing the female thin-ideal and were asked to respond to their body-related feelings according to the instructions. Outcomes assessed were body dissatisfaction, and positive and negative affect.

RESULTS

Results indicated a significant increase of body satisfaction in the acceptance and reappraisal conditions from pre- to post-induction of body dissatisfaction, compared to control group which suffered a significant decrease in body satisfaction. Moreover, in the control group, positive affect significantly decreased and negative affect increased from pre- to post-induction, and did not change significantly, neither in the acceptance nor in the reappraisal condition.

CONCLUSIONS

Our findings highlight the positive effects of acceptance and reappraisal as emotion regulation strategies on body dissatisfaction and on positive and negative affect.

LEVEL OF EVIDENCE

Experimental study, Level 1.

The Portuguese version of the body investment scale: psychometric properties and relationships with disordered eating and emotion dysregulation

BACKGROUND

This study aimed to examine the psychometric properties of the Portuguese version of the Body Investment Scale (BIS) in a nonclinical sample of students and a clinical sample of outpatients with eating disorders, to analyse the differences in the BIS factors between the samples and to explore the relationships among body investment, eating disorder symptoms and difficulties in emotion regulation.

METHODS

The clinical (n = 93) and nonclinical (n = 448) samples completed self-report measures.

RESULTS

In contrast to the nonclinical sample, confirmatory factor analysis showed an acceptable fit for the original four-factor solution of the BIS in the clinical sample. This scale also demonstrated adequate internal consistency in both samples. Significant differences in BIS factors were found between the samples; outpatients with eating disorders presented more negative feelings about the body, less comfort with touch and lower levels of body protection than those of the students. In the clinical sample, significant relationships were found between these factors and a higher severity of disordered eating, as well as between these factors and higher difficulties in emotion regulation.

CONCLUSIONS

The Portuguese version of the BIS is a psychometrically sound measure for the assessment of body investment, and it is especially appropriate in a clinical setting of outpatients with eating disorders.

Adolescent Body Dissatisfaction in Contrasting Socioeconomic Milieus, Coming from a French and Luxembourgish Context

Purpose: To analyze the relationships between body mass index (BMI), ideal body, current declared body shape, and gap between ideal and declared body shape, and the associations that these have with social and cultural factors among 329 adolescents (11 to 15 years i.e., at two stages of adolescence, the early and late adolescence), attending an international school in Luxembourg, and 281 from Paris. Methods: A cross-sectional survey was conducted using an online questionnaire. Missing data were addressed using the data augmentation method in a Bayesian framework. Results: For both sets, higher the BMI and bigger their current body shape (CBS), the slimmer their ideal body shape, especially for those who perceive a link between body shape and beauty. For girls, slimness is a shared ideal; for boys, older they are, more they want a muscular body shape. Most students want slimmer bodies, but in affluent or intermediate social milieu students in relations to identification to personalities such as celebrities, while students from modest milieus, this is expressed in relation to success in love. In addition, they declared that their “talk diet with friends” were associated with large gap between ideal and declared body shape. Conclusions: A social control norm was revealed involving a displacement of values affecting body weight and health in the late stage of adolescence to early adolescence, especially for boys.

Weight-Related Selves and Their Relationship With Body Mass Index Among Young Individuals in Curaçao

Based on the assumptions of self-discrepancy theory, the present study examined the degree of overweight, weight-related body images, and the relation between these images and body mass index (BMI) among two samples of young people from Curaçao (secondary school students, n = 176; undergraduate students, n = 205). In addition to BMI, participants reported their current, ideal, and most feared body sizes, the thinnest and largest body sizes still acceptable to them, and the body size they considered the healthiest by means of the Contour Drawing Rating Scale. We expected females to show a larger discrepancy between current and ideal body size than males (Hypothesis 1) and that this discrepancy (as an indicator of body dissatisfaction) would be related more strongly to BMI among females than among males (Hypothesis 2). Results yielded support for Hypothesis 1 among secondary school students only. Only in the undergraduate sample, BMI and body dissatisfaction were related, but equally so for males and females. Possible explanations are discussed as well as implications for weight management interventions.

[Tripartite Influence Scale (TIS) applied to university students: validation study and application]

The Tripartite Influence Scale (TIS) is used to assess the influence of social and family factors on individuals' body image. However, little evidence has been presented on the validity of the TIS construct. The study aimed to estimate the psychometric indicators in TIS and identify the degree of influence of the media, parents, and peers on body image in university students, considering different characteristics. University students of both sexes participated. The psychometric indicators in TIS were assessed for each sex using confirmatory factor analysis. Mean scores were calculated for each TIS factor. Prevalence rates for degree of influence were presented. A multivariate regression model was built to verify the relationship between target characteristics and TIS factor scores. The sample included 791 university students (63.2% women) 18 to 40 years of age. TIS did not initially display a good fit to the samples and was therefore refined. After refinement, the scale showed adequate validity and reliability for women and men. Significant differences were observed in the mean scores between women and men, and in the prevalence rates the majority of the students were in the low category. Work, consumption of food supplements for body changes, age, body mass index, self-rated diet, and level of physical activity were significantly related to TIS factors. Women were generally more influenced than men by the media and peers. Characteristics identified as related to TIS can be relevant for inclusion in clinical and research protocols.