The relationship between body weight and dietary restraint is explained by body dissatisfaction and body image inflexibility among young adults in China

Validation of the Chinese Version of the Body Image Flexibility and Inflexibility Scale among Chinese College Students

Body image flexibility is a specific type of psychological flexibility relevant to body image. The development of the Body Image Flexibility and Inflexibility Scale (BIFIS) expands the concept and structure of body image flexibility and provides more detailed measurement indicators for theoretical research and clinical practice. However, the tool's applicability to the Chinese population is still unclear. This study aims to test the reliability and validity of the BIFIS among Chinese college students. A total of 1446 Chinese college students were surveyed and completed a series of scales, including the Chinese version of the BIFIS (i.e., C-BIFIS). A total of 99 participants were retested one month later. Confirmatory factor analysis supported the second-order factor structure of the BIFIS. The C-BIFIS showed measurement invariance across genders. The scale also exhibited good internal consistency and test-retest reliability. The higher-order body image flexibility and inflexibility factors were significantly correlated with unidimensional body image flexibility, body satisfaction, body appreciation, intuitive eating, and life satisfaction. Incremental validity tests indicated that two higher-order factors remained unique predictors of intuitive eating and life satisfaction. In conclusion, the Chinese version of the BIFIS has good psychometric properties and could be used to study body image flexibility in Chinese college student populations.

The association between appetite and eating behaviors among Chinese female university students

Background

Young females are at a higher risk of developing unhealthy eating behaviors. This study investigated the relationship between appetitive traits and eating behaviors among female university students.

Methods

The study participants were 520 female university students from a public university in Eastern China. Appetitive traits were assessed using the Chinese version of the Adult Eating Behavior Questionnaire (C-AEBQ). Data on eating behaviors, including food intake frequency, meal regularity, and dieting behavior, were collected using self-administered questionnaires. The body mass index (BMI) was calculated using self-reported data. Pearson's and Spearman's correlations were used to correlate appetitive traits with BMI and eating behaviors. Latent profile analysis (LPA) was used to identify different appetitive patterns, and logistic regression was used to analyze the relationship between different appetitive patterns and eating behaviors.

Results

Two food-approach traits (food enjoyment and emotional over-eating) were positively correlated with BMI, while two food-avoidance traits (slowness in eating and satiety responsiveness) showed negative correlations. Food responsiveness was linked to a higher intake of delivered food, spicy food, and sugar-sweetened beverages, whereas satiety responsiveness was correlated with more frequent meal skipping. The LPA identified four appetitive patterns: food approachers, food approachers with emotional under-eating, food avoiders, and food avoiders with emotional over-eating. Food avoiders had significantly lower BMI than the other groups. Compared to food approachers, food avoiders skipped breakfast more frequently, and food avoiders with emotional over-eating skipped both breakfast and lunch more often. After adjusting for BMI, appetitive patterns showed no significant relationship with dieting behavior.

Conclusion

Among female university students, appetitive patterns correlated with eating behaviors, and students with food-avoidance patterns had a higher risk of meal irregularity. These findings emphasize the importance of implementing trait- and pattern-specific approaches to promote healthy eating behaviors among female university students.

Prevalence and Influencing Factors of Central Obesity among Adults in China: China Nutrition and Health Surveillance (2015-2017)

The purpose of this study was to describe the prevalence of central obesity and its influencing factors among Chinese adults aged 18 or older. The data were from China Nutrition and Health Surveillance (2015-2017), which used a stratified, multistage, random sampling method. A total of 145,298 adults aged 18 years or older from 31 provinces were included in this study. The Criteria of Weight for Adults promulgated by China in 2013 were used to determine central obesity. Out of all the adults investigated, 48,342 were identified with central obesity, with a prevalence rate of 33.3%. A logistic analysis suggested that the following factors were associated with central obesity: female sex [odds ratio (OR) = 1.329, 95%CI = 1.277~1.384]; increasing age [OR (95%CI): 1.146 (1.061~1.238), 1.254 (1.167~1.348), 1.774 (1.651~1.907), 2.041 (1.894~2.198), 2.434 (2.239~2.647)]; being married [OR = 1.184, 95%CI = 1.077~1.302]; being divorced or widowed [OR = 1.132, 95%CI = 1.006~1.273]; an urban setting [OR = 1.096, 95%CI = 1.061~1.132]; BMI [OR (95%CI): 0.159 (0.095~0.266), 12.645 (11.388~14.042), 180.989 (153.025~214.064)]; drinking [OR = 1.069, 95%CI = 1.031~1.109]; and screen time > 5 h [OR = 1.088, 95%CI = 1.036~1.141] were risk factors for central obesity; while education above primary school [OR (95%CI): 0.905 (0.875~0.936), 0.857 (0.802~0.915)] and sufficient physical activity [OR = 0.819, 95%CI = 0.782~0.858] were protective factors for central obesity. This study revealed that the prevalence of central obesity, which differed by gender and age, is still high. Large differences between different groups and geographic regions exist persistently. Effective, sustainable, and culturally targeted interventions are needed.

Effects of a Comprehensive Dietary Intervention Program, Promoting Nutrition Literacy, Eating Behavior, Dietary Quality, and Gestational Weight Gain in Chinese Urban Women with Normal Body Mass Index during Pregnancy

In urban Chinese women with normal body weight during pregnancy, we implemented a comprehensive dietary intervention program aimed at enhancing nutrition literacy, dietary quality, and gestational weight gain. The methods included both online and offline health education on prenatal nutrition, weekly weight monitoring, family back education practices, and real-time dietary guidance. The intervention was delivered to randomly assigned control and intervention group participants from gestational week 12 to week 24. The intervention group (n = 44; 100% complete data) showed significant differences (mean (SD)) compared to the control group (n = 42; 95.5% complete data) in nutrition literacy (53.39 ± 6.60 vs. 43.55 ± 9.58, p < 0.001), restrained eating (31.61 ± 7.28 vs. 28.79 ± 7.96, p < 0.001), Diet Quality Distance (29.11 ± 8.52 vs. 40.71 ± 7.39, p < 0.001), and weight gain within the first 12 weeks of intervention (4.97 ± 1.33 vs. 5.98 ± 2.78, p = 0.029). However, there was no significant difference in the incidence of gestational diabetes (2 (4.5%) vs. 4 (9.5%), p = 0.629). Participants in the intervention group reported an overall satisfaction score of 4.70 ± 0.46 for the intervention strategy. These results emphasize the positive role of comprehensive dietary intervention in promoting a healthy diet during pregnancy.

Psychometric properties and factor structure of the Revised Beliefs About Emotions Questionnaire

OBJECTIVE

Given that there is an increasing exploration of the role of beliefs about emotions in emotion regulation and psychotherapy, there is a need for a range of valid and reliable measures of beliefs about emotions. The Beliefs About Emotions Questionnaire (BAEQ) has been shown to be a promising measure of beliefs about emotions. However, to date, no study has attempted to replicate the original factor structure of the BAEQ in an English-speaking country. The present study examined the psychometric properties of the BAEQ in a nonclinical sample.

METHOD

Archival data of 1807 adult participants residing in Australia was divided into three equal groups of participants. A confirmatory factor analysis (CFA) was conducted on the first sub-sample, an exploratory factor analysis (EFA) was performed on the second sub-sample, and a second CFA was performed on the third sub-sample. Divergent validity was tested using the heterotrait-monotrait ratio and the concurrent validity was tested through correlations with the subscales of the Three-Factor Eating Questionnaire (TFEQ-R18).

RESULTS

The first CFA failed to replicate the original factor structure of the BAEQ. An EFA supported five of the original six factors. A five-factor structure, including 30 out of the original 43 items, was confirmed in a second CFA. The final subscales (Shameful and Irrational, Overwhelming and Uncontrollable, Invalid and Meaningless, Useless and Damaging) demonstrated good construct validity, good internal consistency, and good concurrent and divergent validity.

CONCLUSION

The results from this study support a briefer five-factor, 30-item version of the BAEQ (BAEQ-R) as a reliable and valid measure of beliefs about emotions that can be utilised in future research.

Chinese university students showed less disordered eating during the COVID-19 campus lockdown

OBJECTIVE

The rapid spread of the Omicron variant of COVID-19 in China had resulted in campus lockdown in many universities since February 2022, profoundly affecting students' daily lives. Campus lockdown conditions differ considerably from home quarantine, so that the eating patterns of university students may be different. Thus, the current study aimed to: (1) investigate university students' eating patterns during campus lockdown; (2) identify factors associated with their disordered eating.

METHOD

An online survey about recent life changes, disordered eating, stress, depression, and anxiety was carried out from April 8th to May 16th, 2022. A total of 2541 responses from 29 provinces/cities of China were received.

RESULTS

2213 participants were included in the main analysis, and other 86 participants were analyzed separately as a subgroup due to their diagnosis of eating disorder. Participants who were undergoing campus lockdown (the lockdown group) showed less disordered eating than those who had never been in campus lockdown (the never-lockdown group), as well as those who had experienced campus lockdown before (the once-lockdown group). However, they perceived more stress and felt more depressed. Being female, higher BMI, gaining weight, increasing exercise, spending more time on social media, higher level of depression and anxiety were all related to disordered eating in the lockdown group.

CONCLUSIONS

Disordered eating among Chinese university students was less prevalent during campus lockdown due to the strict and regular diet. However, there is a potential risk of "revenge eating" after campus lockdown ends. Thus, there should be further tracking and related prevention.

LEVEL OF EVIDENCE

IV, uncontrolled trials without any interventions.

Exploring the links between celebrity worship, body dissatisfaction, and disordered eating among young adult celebrity worshippers in China

Considerable evidence exists on the associations of celebrity worship with body dissatisfaction and disordered eating. However, relevant findings are confined to Western contexts and thinness-oriented body dissatisfaction and disordered eating. Consequently, the relationships of celebrity worship with muscularity-oriented body dissatisfaction and disordered eating are largely underexplored, especially in non-Western countries. Thus, the present study aimed to examine the relationships of celebrity worship with body dissatisfaction and disordered eating in China. A total of 593 young adult celebrity worshippers in China were recruited online. Correlation and mediation analyses were conducted. In contrast to previous findings, celebrity worship was not associated with thinness-oriented body dissatisfaction. However, significant associations were identified between celebrity worship and muscularity-oriented body dissatisfaction for men (r = 0.32, p < .001) and women (r = 0.26, p < .001), thinness-oriented disordered eating for men (r = 0.31, p < .001) and women (r = 0.37, p < .001), and muscularity-oriented disordered eating for men (r = 0.58, p < .001). Body image inflexibility mediated the associations between celebrity worship and disordered eating in men and women. Findings indicate that celebrity worship correlates positively with body dissatisfaction and disordered eating in Chinese young adults.

Psychometric properties of the Chinese version of the Female Muscularity Scale among Chinese young women

PURPOSE

The Female Muscularity Scale (FMS) was specifically developed for assessing drive for muscularity in women. The current study aimed to translate the FMS into Chinese (FMS-C) and examine its psychometric properties among Chinese young women.

METHODS

Based on standard procedures, the FMS was translated into Chinese. By using the psych and lavaan packages on R version 4.0.3, the current study examined the factor structure, reliability, and convergent and incremental validity of the FMS-C with a sample of 517 Chinese women college students ([Formula: see text]= 18.86 years).

RESULTS

Results showed a 2-factor structure including attitudes and behaviors of the FMS-C. The internal consistency reliability (Cronbach's α) was .91 for the total FMS-C scale and .89 and .88 for the Attitudes and Behaviors subscales, respectively. Results also revealed evidence for good convergent and incremental validity of the FMS-C.

CONCLUSION

Findings suggest that the FMS-C can be a useful tool to measure both attitudes and behaviors underlying drive for muscularity and muscle tone concerns among Chinese young women.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Body mass index and quality of life in individuals with polycystic ovary syndrome: Dysmorphic concerns and eating disorders as mediators

Objective

Weight issues, dysmorphic concerns and eating disorders are common among individuals with polycystic ovary syndrome (PCOS) and are linked to poor quality of life (QoL). The goal of the current study was to examine whether the association between body mass index (BMI) and QoL was mediated by dysmorphic concerns, examining also the relations with eating disorder symptomatology.

Methods

Questionnaires were administered to 435 individuals with PCOS aged between 18 and 40 years (M = 27.62; SD = 4.83) to measure dysmorphic concerns, eating disorder symptoms and QoL. Participants were also asked to report their height and weight to compute their BMI.

Results

Structural equation modeling was used to observe the relationship between the variables. The results revealed a direct relationship between QoL, BMI, dysmorphic concerns and eating disorder symptomatology. In addition, dysmorphic concerns were related to BMI and eating disorder symptomatology. Furthermore, the results showed the mediating role of dysmorphic concerns and eating disorder symptoms in the relationship between BMI and QoL.

Conclusion

The current results highlight the potential importance of harmful relationships with one's own body and food, explaining why weight issues may be linked to different levels of QoL in PCOS individuals. The implications of these findings are discussed.

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).

Is the relationship between BMI and body appreciation explained by body dissatisfaction and body image inflexibility among older adults? A study among older Chinese men and women

A number of previous studies reported a link between body mass index (BMI) and body appreciation; however, many of these studies were conducted in Western countries and addressed younger samples. Older adults, especially in East Asia, remain insufficiently examined. Therefore, the objective of this study was to examine the relationship between BMI and body appreciation and to explore two potential mediators, body dissatisfaction and body image inflexibility, as proposed in a previous meta-analysis. A community-based cross-sectional study was performed among 313 older Chinese men and women (M = 67.90, SD = 7.94). Mediation tests were conducted to examine the roles of body dissatisfaction and body image inflexibility in the relationship between BMI and body appreciation. BMI correlated significantly with body appreciation, body dissatisfaction, and body image inflexibility among older women but did not correlate with body appreciation among older men. Body dissatisfaction and body image inflexibility emerged as significant mediators in the relationship between BMI and body appreciation among older Chinese women. Reducing body dissatisfaction and body image inflexibility may be potential targets for helping older women with high BMI to promote their body appreciation.

Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis

BACKGROUND

Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented.

METHODS

This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%.

RESULTS

Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set.

CONCLUSIONS

Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China.

Association of body perception and dietary weight management behaviours among children and adolescents aged 6-17 years in China: cross-sectional study using CHNS (2015)

Background

Obesity is rapidly globally increasing. Meanwhile, there is an increase in negative perception of the body image and, consequently, an increase in weight control management. Body perception plays an important mediating role between overweight or obesity and weight control behaviours. This study aims to examine whether body perception is associated with dietary weight management behaviours among Chinese children and adolescents.

Methods

Child body perception and health behaviours from Chinese Health and Nutrition Survey (2015) were assessed, and 729 boys and 640 girls who aged 6 to 17 years were included in this study. Variables assessed as covariates were sociodemographic, physical activity and body perception involving self-perceptive weight status and body image dissatisfaction (BID). Multivariate logistic regression was used to explore the association between dietary weight management behaviours and body perception.

Results

60.77% students rightly matched their body mass index (BMI) with self-perceived weight. The prevalence of BID was 59.39%. After adjustment for sociodemographic information, physical activities and BMI, those whose self-perceived weight status as overweight/obesity were associated with an increased risk of dietary weight management behaviours comparing to those who have normal weight in boys (OR = 5.07; 95% CI = 1.86, 13.87; P < 0.001) and girls (OR = 14.28; 95%CI = 5.73, 35.56; P < 0.001). And those who desire to be thinner were strongly associated with dietary weight management behaviours (OR = 9.51; 95%CI = 3.47, 26.09; P < 0.001) comparing to those who were satisfied with their body image in girls.

Conclusions

The results revealed that body perception had a significant association with dietary weight management behaviours and exited the discrepancy according to sex. It is necessary to promote healthy awareness of body perception and to establish self-motivation for improving basic health knowledge in school health education activities.

The Relationship between Restrained Eating, Body Image, and Dietary Intake among University Students in China: A Cross-Sectional Study

This study aims to explore the association between restrained eating, body image, and dietary intake among Chinese college students. This cross-sectional study included 1301 college students at two universities in Hunan Province. Electronic questionnaires were used to collect information including students’ demographic characteristics, restrained eating, perception of body weight, body satisfaction, and dietary intake. Anthropometric measurements were collected to calculate body mass index (BMI). The prevalence of high restrained eating was 52.8%. Students who were dissatisfied with their bodies or overestimated their body weight showed a higher tendency toward high restrained eating (p < 0.05). Students with high restrained eating tended to eat fruits and eggs more frequently, while the frequency of eating domestic animals and poultry, sugar-sweetened beverages, and fast food were the opposite. Moreover, high restrained eating was a risk factor for low dietary diversity (odds ratio (OR) = 1.384, 95% confidence interval: 1.002~1.912). The high incidence of restrained eating among Chinese college students and its energy-restricted diets that may lead to possible health implications require attention. Further studies are needed to investigate the characteristics of college students’ restrained eating to tailor appropriate interventions for forming positive body images and promoting healthy eating behaviors, thus, improving dietary quality.