Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action

Psychometric Properties of the Preference for Intuition and Deliberation in Eating Decision-Making Scale among Brazilian Adult Women

The Preference for Intuition and Deliberation in Food Decision-Making Scale (E-PID) was developed to evaluate both intuitive and deliberative food decision-making within a single instrument. However, its psychometric properties have only been assessed among German-speaking participants. The main aim of the present study was to evaluate evidence of validity and reliability of the E-PID among 604 Brazilian adult women. Exploratory (n = 289) and confirmatory factor analyses (n = 315) were conducted to evaluate the factor structure of the E-PID. Convergent validity was assessed correlating the E-PID with measures of eating behaviors (Tree-Factor Eating Questionnaire-18), intuitive eating (Intuitive Eating Scale-2), and a measure of beliefs and attitudes towards food (Food-Life Questionnaire-SF). McDonald's Omega coefficient (ω) was used to test the internal consistency of the E-PID. Results from an exploratory and confirmatory factor analysis supported a two-factor structure with seven items. We found good internal consistency (McDonald's ω = 0.77-0.81). Furthermore, the E-PID demonstrated adequate convergent validity with measures of intuitive, restrictive, emotional and uncontrolled eating, and beliefs and attitudes towards food. Results support the use of the E-PID as a measure of intuition and deliberation in food decision-making among Brazilian adult women, expanding the literature on eating decision-making styles.

Eating disorder risk among Australian youth starting a diet in the community

Dieting is a potent risk factor for eating disorder (ED) symptoms and development, which typically occur in late adolescence. However, as diets are often motivated by body image concerns (another core ED risk factor), dieters may already carry heightened ED risk. Thus, the current study aimed to document ED risk among young people starting a diet in the community. Young people (16-25 years) starting or intending to start a self-initiated diet (N = 727) provided data via a screener questionnaire, assessing containing sociodemographic factors, past and current ED symptoms and behaviours. Over a third (36.9%) screened using a validated instrument were found to be at-risk of a current ED, with 10% above the clinical cut-off. Consistent with this finding, over 10% of the sample self-reported experiencing a lifetime ED, while nearly a quarter reported symptoms consistent with an ED diagnosis with no reported formal diagnosis. Findings suggest a high level of ED risk among young people starting a diet in the community and point to the need for more proactive measures targeted at this cohort (e.g., screening, monitoring). Further education on the risks of dieting and encouragement for help-seeking in young people is indicated.

The relationship between racial/ethnic identification and body ideal internalization, hair satisfaction, and skin tone satisfaction in black and black/white biracial women

Eurocentric physical characteristics, including a thin, tall physique, long straight hair, and fair skin, typify Western beauty standards. Past research indicates that for Black women, greater identification with one's racial/ethnic culture may buffer against internalizing Eurocentric beauty standards, specifically the thin ideal. Black/White Biracial women often experience different appearance pressures from each of their racial identity's sociocultural appearance ideals. Unfortunately, body image research is limited among Bi/Multiracial individuals. Participants were recruited online via Prime Panels, a high-quality data recruitment service provided by CloudResearch. Participants, M(SD)Age= 34.64 (12.85), self-reported their racial/ethnic identification, thin and thick/curvy ideal internalization, and hair and skin tone satisfaction. Using linear regression analyses, we assessed whether racial/ethnic identification buffered against monoracial Black (n = 317) and Black/White Biracial (n = 254) women's thin ideal internalization. Additionally, we assessed whether stronger racial/ethnic identity was associated with stronger thick/curvy ideal internalization and hair and skin tone satisfaction. Supporting hypotheses, greater racial/ethnic identification was associated with higher thick/curvy ideal internalization and hair and skin tone satisfaction among both Black and Biracial women. Contrary to hypotheses, greater racial/ethnic identification was not associated with lower thin ideal internalization in either group. Our results stress the need to use racially and culturally sensitive measurements of body image.

Athlete Body Image and Eating Disorders: A Systematic Review of Their Association and Influencing Factors

Body image and eating disorders pose significant challenges to the overall health of athletes. However, divergent findings exist regarding the potential association between athletes' body image and eating disorders. This systematic review aims to examine the relationship between these two variables and identify the modifiers of the association, such as gender, age, race, and exercise type. A search was conducted in five databases (Web of Science, PubMed, APA PsycINFO, ProQuest, and EBSCO), aiming to identify studies on athletes and involved body image and eating disorders in their conclusions. Ultimately, thirty-one studies were included for systematic evaluation. The results of the studies indicate that the relationship between athletes' body image and eating disorders is complex and inconclusive. In some types of sports, eating disorders can occur even when athletes are satisfied with their body image. Furthermore, female athletes, particularly young female athletes, and athletes involved in sports associated with leanness are more prone to eating disorders and body dissatisfaction. Due to limited resources in this type of research, there is a lack of comprehensive inclusivity across sports disciplines, genders, races, and levels of sports proficiency, which warrants further research.

Recreational Physical Activity and the Mediterranean Diet: Their Effects on Obesity-Related Body Image Dissatisfaction and Eating Disorders

Obesity is a non-communicable disease that is associated with a number of serious physical and mental health conditions. The present study examines the effect of recreational physical activity and the Mediterranean diet on body image dissatisfaction and propensity for eating disorders. It is based on 1311 participants categorized by body mass index (BMI) into a normal ΒΜΙ group (NBG; N = 513), an overweight and obese ΒΜΙ group (OBG; N = 492), and a control group (CG; N = 309). All participants completed the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS), Rosenberg Self-esteem Scale (RSES), Eating Attitudes Test-26 (EAT-26), Mediterranean Diet Score (MedDietScore), and Fitness Evaluation and Fitness Orientation subscales from the original Multidimensional Body-Self Relations Questionnaire (MBSRQ). The results of the multiple regression analysis indicated that the overall prediction of the variables was statistically significant. A multivariate analysis of variance (MANOVA) demonstrated the existence of significant interactions between groups and gender across a range of scales. Despite higher body image dissatisfaction in the OBG group, they maintained positive self-esteem and did not exhibit eating disorder tendencies. Notably, women reported greater dissatisfaction than men across all three groups. Our findings have practical implications for public health promotion strategies, policymaking, future research, and clinical practice. Encouraging regular exercise and adherence to the Mediterranean diet could improve body satisfaction and reduce eating disorder risk. Policymakers can advocate for community-based policies promoting physical activity and healthy eating habits.

Adolescent Females' Dyadic Conversations About Body, Weight, and Appearance

Body talk among adolescent females has been associated with negative outcomes, including depressed mood, disordered eating, and body dissatisfaction. Yet, little work has investigated the manifestation of body talk in actual conversations between adolescent females or explored pathways through which body talk is spread (e.g., co-rumination). The present study examined body talk among adolescent female dyads (N = 23 dyads) ages 13 to 17 (Mage = 15.12) using an observational design. Reciprocally nominated dyads were recruited from a high school in the southeastern United States. Conversations between dyads were qualitatively coded using an applied thematic analysis approach. Identified themes were related to weight, appearance, and personality. Results provide insight into the social context in which sociocultural norms of weight stigma, body dissatisfaction, and eating-related psychopathology may be reinforced. Findings have implications for informing the development of interventions to reduce co-rumination of negative weight- and appearance-related body talk and to promote positive body image and healthy weight among adolescent girls.

Profiles of body image concerns and their associations with disordered eating behaviors

Although body image concerns (BIC) are recognized as a core driver in the development of disordered eating behaviors, the combined role of various types of BIC remains underexamined. This study relied on latent profile analysis to identify the main configurations of self-reported BIC (i.e., body checking and avoidance, perceived physical appearance, and fear of negative appearance evaluation) observed in a sample of 419 French-Canadian individuals (Mage = 26.59, SDage = 9.23). The role of body mass index, sex, and age on profile membership was also examined, as well as the relation between profile membership and disordered eating behaviors (i.e., dieting, bulimia and food preoccupation, and oral control). Six distinct BIC profiles differing in terms of shape and level were identified, with women being more likely to display a profile characterized by higher levels of BIC. In turn, profiles characterized by higher levels of BIC were associated with more disordered eating behaviors. The present study can broaden our understanding of the onset and maintenance of disordered eating behaviors and inspire the development of more tailored body-image interventions.

When Eating Intuitively Is Not Always a Positive Response: Using Machine Learning to Better Unravel Eaters Profiles

BACKGROUND

The aim of the present study was to identify eaters profiles using the latest advantages of Machine Learning approach to cluster analysis.

METHODS

A total of 317 participants completed an online-based survey including self-reported measures of body image dissatisfaction, bulimia, restraint, and intuitive eating. Analyses were conducted in two steps: (a) identifying an optimal number of clusters, and (b) validating the clustering model of eaters profile using a procedure inspired by the Causal Reasoning approach.

RESULTS

This study reveals a 7-cluster model of eaters profiles. The characteristics, needs, and strengths of each eater profile are discussed along with the presentation of a continuum of eaters profiles.

CONCLUSIONS

This conceptualization of eaters profiles could guide the direction of health education and treatment interventions targeting perceptual and eating dimensions.

A meta-analytic review of impact of measurement choice on RCTs to reduce appearance internalization

OBJECTIVE

Prior reviews have shown that interventions targeting internalization of appearance standards are generally efficacious, though there is considerable heterogeneity in estimates across studies. This updated review of the literature evaluates whether efficacy estimates from RCTs systematically vary as a function of three related outcome measures (internalization, awareness, and perceived pressure regarding appearance standards).

METHODS

Seven electronic databases were systematically searched from inception to February 8, 2023. The Cochrane Risk of Bias tool assessed each study's risk of bias. Studies included were randomized-controlled trials evaluating body image/eating disorder prevention or intervention programs targeting internalization as a focal point of treatment. Effect sizes were meta-analyzed and meta-regression analyses were conducted investigating the impact of outcome measure choice on study effect size at post-intervention and follow-up.

RESULTS

Thirty-seven studies (N = 4809 participants) were included. The meta-analytic findings as expected found interventions efficacious at reducing internalization post-intervention (d = -0.47, 95% CI [-0.60 to -0.34], k = 44), and at follow-up (d = -0.28, 95% CI [-0.39 to -0.17], k = 43), but also highly heterogenous (I2  = 52-67%). Operationalization of internalization moderated results at follow-up but not post-intervention timepoints, with awareness measures (compared with internalization measures) producing weaker effect sizes. Exploratory analyses found bigger effects when internalization was compared with all other measurement categories combined, suggesting possible issues with statistical power in main analyses.

DISCUSSION

Mixed present findings suggest need for further evaluation of measurement effects on efficacy, and possible caution in choice of outcome measure for internalization-based interventions.

PUBLIC SIGNIFICANCE STATEMENT

This review provides some preliminary evidence that choice of survey measures used in randomized controlled trials can impact our judgments about whether a trial reduces the extent to which participants endorse unrealistic appearance standards. Accuracy in measurement of this efficacy of trials is crucial, given the role that internalized appearance standards play in onset and maintenance of eating disorders.

Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder in adolescent girls and relations of prodromal symptoms to future onset of these eating disorders

BACKGROUND

To advance knowledge regarding the etiology of eating disorders, we characterized the sequencing of eating disorder symptom emergence for adolescent girls who subsequently developed anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) for community-recruited adolescents and tested whether prodromal symptoms increased risk for future onset of each eating disorder.

METHODS

Data collected from adolescent girls (N = 496; M age = 13.02, s.d.= 0.73) who completed a diagnostic interview annually over an 8-year period were used to address these aims.

RESULTS

For all four eating disorders, compensatory weight-control behaviors were the first behavioral symptom to emerge and weight/shape overvaluation was the first cognitive symptom to emerge. Moreover, lower-than-expected BMI predicted future AN onset, binge eating and all cognitive symptoms predicted future BN onset, weight/shape overvaluation predicted future BED onset, and compensatory behavior and all cognitive symptoms predicted future PD onset. These predictive effects were small-to-large in magnitude. Collectively, prodromal symptoms predicted an eating disorder onset with 83-87% accuracy.

CONCLUSIONS

Results suggest that compensatory weight-control behaviors and weight/shape overvaluation typically emerge before other prodromal symptoms in all eating disorders during adolescence. Moreover, different prodromal symptoms seem to predict future onset of different eating disorders. Screening adolescent girls for these prodromal symptoms and implementing indicated prevention programs designed to reduce these symptoms may prove effective in preventing future onset of eating disorders.

Evidence that a novel transdiagnostic eating disorder treatment reduces reward region response to the thin beauty ideal and high-calorie binge foods

BACKGROUND

Findings from brain imaging studies with small samples can show limited reproducibility. Thus, we tested whether the evidence that a transdiagnostic eating disorder treatment reduces responsivity of brain valuation regions to thin models and high-calorie binge foods, the intervention targets, from a smaller earlier trial emerged when we recruited additional participants.

METHODS

Women with DSM-5 eating disorders (N = 138) were randomized to the dissonance-based body project treatment (BPT) or a waitlist control condition and completed functional magnetic resonance imaging (fMRI) scans assessing neural response to thin models and high-calorie foods at pretest and posttest.

RESULTS

BPT v. control participants showed significantly greater reductions in responsivity of regions implicated in reward valuation (caudate) and attentional motivation (precuneus) to thin v. average-weight models, echoing findings from the smaller sample. Data from this larger sample also provided novel evidence that BPT v. control participants showed greater reductions in responsivity of regions implicated in reward valuation (ventrolateral prefrontal cortex) and food craving (hippocampus) to high-calorie binge foods v. low-calorie foods, as well as significantly greater reductions in eating disorder symptoms, abstinence from binge eating and purging behaviors, palatability ratings for high calorie foods, monetary value for high-calorie binge foods, and significantly greater increases in attractiveness ratings of average weight models.

CONCLUSIONS

Results from this larger sample provide evidence that BPT reduces valuation of the thin ideal and high-calorie binge foods, the intervention targets, per objective brain imaging data, and produces clinically meaningful reductions in eating pathology.

Translation and psychometric properties of the Chinese version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) in college students

The current study aimed to translate the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) into Mandarin Chinese and to examine its psychometric properties. In Study 1 (N = 842, 427 women, 415 men), exploratory factor analysis supported a 4-factor solution for the Mandarin Chinese SATAQ-4, namely Internalization: Thin/Low body fat, Internalization: Muscular/Athletic, Pressures: Family/Peers, and Pressures: Media. Evidence also supported the high internal consistency and convergent validity of the male-subject and female-subject versions of Mandarin Chinese SATAQ-4. In Study 2 (N = 497, 290 women), confirmatory factor analyses supported the previously found 4-factor model, after allowing correlation between residuals of three pairs of items. In Study 3 (N = 294, 129 women), we examined the 3-month test-retest reliability across gender, and the results showed satisfactory ICC for both women (ICC =0.53-0.79) and men (ICC =0.56-0.66). Taken together, the male-subject and female-subject versions of the Mandarin Chinese SATAQ-4 are reliable and valid in evaluating sociocultural attitudes towards appearance.

Body talk on social networking sites and restrained eating among adolescents: A test of a multiple mediation model

The present study aimed to examine the link between body talk on social networking sites (SNS body talk) and restrained eating as well as the mediating roles of fear of negative appearance evaluation (FNAE) and body shame in this relationship. Furthermore, the moderating role of gender in the mediation model was also examined. A sample of 1481 Chinese middle and high school students (720 girls, mean age = 15.49 ± 1.84) completed self-reported measures of SNS body talk, FNAE, body shame, and restrained eating. Results showed that SNS body talk was positively associated with restrained eating. FNAE and body shame mediated the association between SNS body talk and restrained eating, separately and serially. Furthermore, gender difference emerged in the path from SNS body talk to body shame and the path from FNAE to body shame. Findings of the present study enrich the literature on social media and body image and eating behaviors, and have important implications for reducing negative body image and disordered eating among adolescents.

Body image dissatisfaction: A novel predictor of poor quality of life in epilepsy

OBJECTIVE

People with epilepsy have long reported reduced quality of life (QoL) compared to healthy peers. This initial study seeks to broaden our understanding of QoL in adults with epilepsy, by examining the adverse impact of body image dissatisfaction for the first time. This aim stems from the observation that both seizures and their medical treatment can cause unwanted changes to physical appearances, such as weight change, hirsutism, and acne.

METHOD

Sixty-three adults with epilepsy and 48 age- and gender-matched healthy controls were recruited from a tertiary epilepsy program and targeted social media. Participants completed an online suite of well-validated questionnaires canvassing state (current) and trait (long-term) aspects of body image dissatisfaction, mood, QoL, and medical history.

RESULTS

People with epilepsy reported significantly elevated levels of trait body image dissatisfaction compared to controls across the dimensions of appearance evaluation, body areas satisfaction, and self-classified weight (p = 0.02); but did not differ from controls on state body image dissatisfaction (p > 0.05). All facets of body image dissatisfaction in participants with epilepsy were strongly associated with reduced QoL, together with heavier body weight, depressive symptoms, medical comorbidities, and a belief that epilepsy hindered their ability to attain a healthier physique. Multiple regression revealed that body image dissatisfaction was the strongest unique contributor to poor QoL in the epilepsy group (β = 0.46, p ≤ 0.001), above and beyond the contribution of current depressive symptoms (β = 0.34, p ≤ 0.01).

SIGNIFICANCE

This is the first study to highlight the high rates of body image dissatisfaction among adults with epilepsy, and the significantly detrimental impact it has on patient well-being. It also opens novel avenues for psychological interventions in epilepsy, that focus on enhancing positive body image as a means of holistically improving the often-poor psychological outcomes for people with this condition.

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

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

Is (Disordered) Social Networking Sites Usage a Risk Factor for Dysfunctional Eating and Exercise Behavior?

BACKGROUND

Research over the past years has shown that exposure to thin and beauty ideals in the media can be associated with disordered eating and related variables. Nowadays, interactive media, such as social networking sites, have gained growing popularity and represent a major part of people's lives. It is therefore crucial to investigate how far users might be negatively influenced by social networking sites regarding eating pathology or excessive exercise behavior and if there are particular links to social media use disorder.

METHODS

Data were collected by an online-survey encompassing questions on regular social networking site use, eating disorders, and excessive exercise behavior.

RESULTS

Analyses showed that disordered social networking sites use was significantly related to eating pathology and a poorer body image in men and women. The frequency of active or passive social networking sites usage however was not associated with exercise behavior.

CONCLUSIONS

Our results confirm that disordered social networking sites use represents a risk factor for body image dissatisfaction and associated eating disorders.

Body perceptions, occupations, eating attitudes, and behaviors emerged during the pandemic: An exploratory cluster analysis of eaters profiles

Introduction

COVID-19 pandemic negatively impacted people's mental and physical health. Three areas have been significantly impacted, among others: eating-related behaviors, occupational balance, and exposure to self-image due to videoconferencing. This study aims to explore and document eaters profiles that were reported during the pandemic in the general Canadian population using a holistic perspective, including body perceptions, attitudes, and eating behaviors (i.e., body image, behaviors, attitudes, and motivations regarding food), and occupations (i.e., physical activity and cooking).

Methods

This cross-sectional study was conducted from May to September 2020. Two hundred and seventy-three Canada's residents, French speaking of 18 years of age and older, participated in an online survey on behaviors, attitudes, and motivations regarding food and eating as well as body image and occupations during the COVID-19 pandemic. A hierarchical cluster analysis was used to determine the eaters profiles. One-way ANOVA and Chi-square test were conducted to differentiate occupational characteristics between eaters profiles.

Results

Three distinctive profiles were found during the COVID-19 pandemic and could be placed on a continuum: the Congruent-driven eater is at the functional pole of the continuum, whereas the Incongruent-driven eater is at the dysfunctional pole of the eaters continuum. In the middle of the continuum, the Incongruent-perceptual eater is at a critical crossing point. Significant differences were reported between eaters profiles.

Discussion

The empirical results based on an eaters continuum conceptualization highlight the importance of understanding how people perceive their body to assess and promote food well-being.

“Why don’t I look like her?” How adolescent girls view social media and its connection to body image

Background

Adolescent girls appear more vulnerable to experiencing mental health difficulties from social media use than boys. The presence of sexualized images online is thought to contribute, through increasing body dissatisfaction among adolescent girls. Sexual objectification through images may reinforce to adolescent girls that their value is based on their appearance. This study explored how sexualized images typically found on social media might influence adolescent girls’ mental health, in positive and/or negative ways.

Methods

In-depth interviews were conducted with girls aged 14–17 years (n = 24) in Perth, Western Australia. Data were analyzed using thematic analysis.

Results

Participants identified body image as a major concern, reporting negative appearance comparisons when viewing images on social media. Appearance comparisons were perceived to exacerbate adolescent girls’ appearance-based concerns. Comparisons also influenced adolescent girls’ efforts to change their appearance and seek validation on social media. The importance of awareness and education from a younger age about social media and its influence on body image was emphasized, as was the need for strategies to promote positive body image and counteract negative body image.

Conclusion

The findings of this study have important implications for professionals working with adolescent girls and for the development of health promotion programs addressing social media use and body image concerns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01845-4.

Development and validation of a scale for the tendency to exercise in response to mood, eating, and body image cues: the Reactive Exercise Scale (RES)

PURPOSE

Earlier work on engaging in physical exercise when experiencing negative affect demonstrated robust associations with eating disorder (ED) behaviors and attitudes; however, measurement of the behavior was primitive, relying on one yes/no question that cannot capture much variability. We report on the development of a self-report measure, the Reactive Exercise Scale (RES), that disentangles the tendency to engage in exercise in response to negative mood cues from the tendency to engage in exercise in response to eating and body image cues, which themselves may be associated with negative mood. The measure also assesses exercising in response to positive mood cues.

METHODS

Exploratory factor analysis (EFA) guided item and factor selection. Confirmatory factor analysis (CFA) in an independent sample tested a 3-factor solution-exercising in response to negative mood cues, eating and body image cues, and positive mood cues. Correlations with exercise attitudes, eating disorder and body image attitudes, mood, and personality were used to evaluate construct validity.

RESULTS

Results supported the 3-factor structure and indicated that exercising in response to negative mood cues may not uniquely relate to most aspects of ED psychopathology when accounting for eating and body image cues, which themselves are associated with negative mood.

CONCLUSION

The RES captures the tendency to exercise in response to negative mood, positive mood, and eating and body image cues. Together, these constructs allow researchers to examine the unique relations of negative mood cued exercise with ED constructs, while accounting for appearance-related motives for which exercise may also be used.

LEVEL OF EVIDENCE

Level III: evidence obtained from well-designed cohort or case-control analytic studies.

The 'not-so-healthy' appearance pursuit? Disentangling unique associations of female drive for toned muscularity with disordered eating and compulsive exercise

Today, many women are driven to subscribe to a more athletically oriented appearance ideal hallmarked by muscle tone (referred to as athletic- or fit-looking). However, the constellation of unhealthy eating and exercise behaviors that may accompany the pursuit of toned muscularity among women is not yet well characterized. To address this knowledge gap, our study evaluated the associations among the female drive for toned muscularity and both thinness-oriented disordered eating behaviors (e.g., dietary restriction) and muscularity-oriented disordered eating behaviors (e.g., excessive scrutiny of macro-nutrient values of food), as well as dimensions of compulsive exercise. Participants were 388 Australian undergraduate women who completed an online questionnaire including self-report measures of said constructs. Hierarchical regression models were used to determine whether the drive for toned muscularity accounted for unique variance in eating and exercise behaviors after adjusting for theoretically relevant covariates. Results indicated independent relationships between the drive for toned muscularity and several facets of thinness- and muscularity-oriented disordered eating, as well as compulsive exercise (e.g., exercise rigidity). Our findings further contribute to an emerging literature illustrating that women driven to attain a toned appearance may be vulnerable to engaging in a wide range of maladaptive eating and exercise practices.

Social network addiction symptoms and body dissatisfaction in young women: exploring the mediating role of awareness of appearance pressure and internalization of the thin ideal

BACKGROUND

Previous studies testing for a direct relationship between social networking sites (SNS) addiction and body dissatisfaction (BD) have yielded inconsistent results. Here, we aimed to identify underlying processes that could mediate this relationship. Specifically, we studied the relationship between SNS addiction symptoms and BD through the awareness of appearance pressures and the internalization of beauty ideals, both individually and serially: SNS addiction → Awareness → BD; SNS addiction → Internalization → BD; SNS addiction → Awareness → Internalization → BD.

METHOD

A total of 368 female undergraduates with SNS accounts completed scales to assess SNS addiction symptoms (Social Network Addiction Questionnaire), BD (Body Shape Questionnaire), awareness, and internalization (Sociocultural Attitudes Towards Appearance Questionnaire-4; awareness and internalization scales). A theoretical serial mediation model was constructed to examine the proposed relationships. Body mass index was included as a covariate to control the influence of this important variable.

RESULTS

The results indicated that both awareness and internalization independently mediated the relationship between SNS addiction symptoms and BD. Also, there was a significant serial mediation effect; women with more SNS addiction symptoms tended to be more aware of appearance pressure, which was associated with the internalization of beauty ideals. In turn, this internalization was positively related to BD symptoms.

CONCLUSIONS

These findings shed light on the indirect relationship between SNS addiction and BD, demonstrating independent and accumulative mediating effects of awareness and internalization.

Body Image and Sexual Well-Being: A Qualitative Study of Women's Perceptions of Partner and Relationship Influences

Women with poorer body image tend to report lower sexual well-being; yet, minimal research has examined interpersonal factors affecting women's body image in the context of sexual activity. We examined women's perceptions of the influence of relationship and partner factors on their body image during sexual activity with their male partner. Semi-structured interviews with 16 young adult women (ages 19-29) revealed that relationship factors (relationship quality and stage) and partner factors (partner's judgment or objectification, compliments from partner, partner's attractiveness, partner's body image, and partner initiation of sexual activity) were perceived as influencing body image in sexual situations.

Internalized Stigma as a Transdiagnostic Factor for Women with Eating Disorders

This study aimed to examine how internalized weight bias (IWB), body surveillance, and body shame relate to eating pathology in women with diagnosed eating disorders (EDs) across the weight spectrum. Previous research has examined these variables in primarily non-clinical populations, binge eating disorder, and higher weight populations. In a sample of 98 women with diagnosed EDs, the association of IWB, body surveillance, and body shame on the severity of ED symptoms was examined with hierarchical multiple regression analyses. Results indicate that IWB, body surveillance, and body shame significantly predicted global eating pathology, F (4, 93) = 40.74, p < .001. IWB, body surveillance, and body shame related to global eating pathology, even after controlling for previous weight bias experiences. Analyses with specific symptom clusters found that only body surveillance predicted dietary restraint, only IWB and body shame predicted overvaluation of shape/weight, and only IWB predicted body dissatisfaction. The findings in this study provide initial support for internalized stigma variables (IWB, body surveillance, and body shame) related to ED pathology in a transdiagnostic clinical eating disorder sample across the weight spectrum. Results suggest that further examination of internalized stigma is needed within ED treatment.

What about being a feminist is protective? An examination of constructs related to feminist beliefs as moderators of the relationship between media awareness and thin-ideal internalization

Feminist beliefs have been identified as a potential protective factor in the relationship between media awareness and thin-ideal internalization; however, the precise reason why feminist beliefs serve this role is unclear. A series of three studies examined the reasons why feminist beliefs may be protective in non-student samples, considering as possible explanations open-minded thinking, critical thinking, and media attitudes and literacy. Study 1 showed that the moderating role of feminist beliefs on the relationship between media awareness and thin-ideal internalization held in a non-undergraduate sample. Study 2 found that feminist beliefs and self-identifying as a feminist were related to open-minded thinking, critical thinking, and media attitudes and literacy. Study 3 found that most of these constructs did not serve the same moderating role as feminist beliefs. However, a complex relationship emerged when both feminist self-identification and media attitudes and literacy were considered simultaneously as moderators, adding to the literature emphasizing that self-identifying as a feminist has a protective role over and above that of merely holding feminist beliefs. These results suggest that feminist beliefs may be a unique combination of these constructs or that there may be yet a different reason why feminist beliefs are protective against thin-ideal internalization.

The Effect of Own Body Concerns on Judgments of Other Women’s Body Size

We investigated the relationships between healthy women’s estimates of their own body size, their body dissatisfaction, and how they subjectively judge the transition from normal to overweight in other women’s bodies (the “normal/overweight” boundary). We propose two complementary hypotheses. In the first, participants compare other women to an internalized Western “thin ideal,” whose size reflects the observer’s own body dissatisfaction. As dissatisfaction increases, so the size of their “thin ideal” reduces, predicting an inverse relationship between the “normal/overweight” boundary and participants’ body dissatisfaction. Alternatively, participants judge the size of other women relative to the body size they believe they have. For this implicit or explicit social comparison, the participant selects a “normal/overweight” boundary that minimizes the chance of her making an upward social comparison. So, the “normal/overweight” boundary matches or is larger than her own body size. In an online study of 129 healthy women, we found that both opposing factors explain where women place the “normal/overweight” boundary. Increasing body dissatisfaction leads to slimmer judgments for the position of the “normal/overweight” boundary in the body mass index (BMI) spectrum. Whereas, increasing overestimation by the observer of their own body size shifts the “normal/overweight” boundary toward higher BMIs.

Modified Dual Pathway Model for Binge Eating: The Role of Emotion Dysregulation

We tested a modification of the dual pathway model using two sequential mediators between body dissatisfaction and binge eating: restricted eating and difficulties in emotion regulation replacing negative affect. A total of 435 college students completed an online survey. Results from path analyses indicated that the relationship between body dissatisfaction and binge eating was not mediated by restricted eating for neither women nor men. However, this relationship was mediated first by restricted eating and then by difficulties in emotion regulation for women only. Moreover, this relationship was mediated by difficulties in emotion regulation for both women and men. A post hoc analysis indicated that the above mediation results were still significant after adding negative affect into the model. No mediations through negative affect were significant. Clinical implications include the conceptualization and intervention of eating concerns within an emotion dysregulation framework.

The Relationship Between Women’s Negative Body Image and Disordered Eating Behaviors During the COVID-19 Pandemic: A Cross-Sectional Study

Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors (i.e., restrictive eating, emotional eating, and overeating) and negative body image (i.e., shape and weight concern, and body dissatisfaction) among a community sample of women during the COVID-19 pandemic (October 2020–May 2021). Furthermore, we explored the possible relation between body image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs.

General and sport-specific weight pressures as risk factors for body dissatisfaction and disordered eating among female collegiate athletes

Female collegiate athletes are a high-risk group for disordered eating. Petrie and Greenleaf's (2007) sociocultural model proposes that both general and sport-related weight pressures lead athletes to internalize unrealistic body ideals, ultimately resulting in body dissatisfaction and disordered eating. In this study, we used structural equation modeling to assess general and sport-specific weight pressures in relation to thin- and muscular-ideal internalization, body dissatisfaction, and disordered eating among 212 female Division I college athletes. General weight pressures from parents, peers, and the media were associated with disordered eating indirectly via thin- and muscular-ideal internalization. In contrast, sport-specific weight pressures were not associated with disordered eating in the full model. After controlling for weight pressures and body ideal internalization, body dissatisfaction was also not associated with disordered eating. These findings suggest that female athletes are vulnerable to weight- and appearance-related pressures from outside the sport context and that the mechanisms underlying the development of disordered eating may differ between athletes and non-athletes.

Secondary effects of body dissatisfaction interventions on adolescent depressive symptoms: A meta-analysis

OBJECTIVE

Depression is a leading cause of disability among adolescents, yet existing treatments are variably effective, suggesting needs to identify novel intervention targets. Body dissatisfaction (BD) may be a promising, but understudied, target: BD is common among adolescents; prospectively associated with future depression; and modifiable through intervention. BD interventions are typically evaluated in terms of impacts on eating disorders, but many trials also measure depression-related secondary outcomes. However, BD intervention effects on depression have not been systematically examined. We, therefore, conducted a meta-analysis to estimate secondary effects of BD interventions on depression symptoms and related outcomes in adolescents (ages 12-19).

METHOD

Our systematic review included randomized controlled trials (RCTs) published between January 2006 and December 2020. Across-group effect sizes were analyzed using robust variance estimation. Preregistered methods, data, and analytic code are available at https://osf.io/734n8/.

RESULTS

The meta-analysis included 13 RCTs, 50 effect sizes, and 6,962 participants. BD interventions led to significant postintervention reductions in depression-related outcomes versus control conditions (g = -0.19 at postintervention, 95% confidence interval: -0.07, -0.31, p = .005). No evidence emerged for moderators of this meta-analytic effect.

DISCUSSION

Overall, BD-focused interventions significantly reduced adolescent depression, with mean postintervention effect sizes comparable to those observed for interventions targeting depression explicitly. Results are bolstered by preregistered methods and robustness checks. Limitations include a lack of data on participants' sexual and gender identities and a significant risk of bias in the underlying literature. Future research on BD interventions should measure depression symptom severity as a secondary outcome.

Body dissatisfaction and ethnic identity are associated with loss of control eating among young adult African American men

African American men are rarely the focus of attention in investigations of loss of control (LOC) eating. Theory and extant data support a robust link between body dissatisfaction and LOC eating behaviors in women. Ethnic identity may buffer this association, as the degree to which racially and ethnically diverse women identify with their ethnic group has been shown to decrease the relevancy of the Western culture body ideal, thereby decreasing disordered eating pathology. These associations have not been evaluated in African American men. The current study examined the link between body dissatisfaction and LOC eating frequency in 261 young African American men (1830 years old). Ethnic identity was evaluated as an independent variable and as a putative moderator. After adjusting for income, education, and body mass index, body dissatisfaction was significantly and positively associated with LOC eating frequency (p < .001). Ethnic identity did not function as a significant moderator (p = .84) but was significantly and inversely associated with LOC eating frequency (p < .001). Although longitudinal studies are needed, these data suggest that there may be multiple pathways through which young African American men engage in LOC eating. Similar to extant research with women and other ethnic groups, body dissatisfaction appears to play a role in the LOC eating of African American men. Additional research is needed to clarify the nature of the association between ethnic identity and LOC eating in this population.

Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders

The stereotype that eating disorders (ED) primarily present among individuals of higher socioeconomic status (SES) has long persisted in popular and professional perception. This belief has likely contributed to disparities in ED identification and treatment, particularly among those of lower SES backgrounds. The objective of this article was to systematically review the literature investigating socioeconomic diversity in distinct ED diagnoses. A PRISMA search was conducted to identify studies that empirically assessed the association between ED pathology and indicators of SES via PubMed and PsycINFO. This search generated 13,538 articles, of which 62 articles published between 1973 and August 2020 met criteria for inclusion in the review. Included studies were primarily cross-sectional and covered diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), with quality ratings of poor, fair, and good. Results are examined in the context of studies' sampling methods, operationalization of SES, and statistical analyses. There is no consistent pattern of evidence to suggest a relationship between high SES and ED. Instead, all ED present across a wide range of socioeconomic backgrounds. Limitations included the predominance of cross-sectional study designs and poor to fair quality ratings. Future research should include adequately powered, community-based longitudinal studies that examine how sociocultural factors, including SES, intersect to influence ED risk and treatment outcome. The existing data suggest an urgent need to prioritize affordable and accessible ED treatment.

Acculturative stress and eating disinhibition among Asian young adults: The role of depressive symptoms and gender

Acculturative stress is associated with health behaviors that have downstream consequences for health outcomes. Eating disinhibition, a behavior characterized by eating emotionally and uncontrollably in the presence of disinhibiting stimuli, has been consistently associated with acculturative stress, but the underlying mechanism is not well-understood. The current study sought to test the role of depressive symptoms and gender on these associations. Asian undergraduate students (N = 477; 78% female) participated in an online cross-sectional study. Higher acculturative stress was associated with higher eating disinhibition (b = 3.45, 95% CI = [0.75, 6.15]), and depressive symptoms showed a partial indirect effect on this association (indirect effect = 0.57, 95% CI_boot = [0.13, 1.34]). Among male young adults (b = 0.98, 95% CI_boot = [0.24, 2.39]), the indirect correlation was stronger than among female young adults (b = 0.44, 95% CI_boot = [0.05, 1.20]; non-significant trend), implying individual differences underlying the indirect effect of depressive symptoms in the acculturative stress and eating disinhibition correlation. The Intercultural Relations dimension of acculturative stress appeared to drive the observed associations. This study is among the first highlighting the role of acculturative stress, depressive symptoms, and gender in eating disinhibition and provides evidence that can inform health professionals to target at-risk Asian individuals with eating problems.

Food insecurity & dietary restraint in a diverse urban population

The primary aim of this study was to investigate self-reported reasons for engaging in dietary restraint (DR) in a food insecure urban population. It also tested whether DR was associated with increased eating disorder (ED) pathology when DR was broadly assessed. The initial sample (N = 503) consisted of adult clients visiting food pantries who completed the Eating Disorder Diagnostic Scale for DSM 5, the Radimer Cornell Food Insecurity Measure, and three items from the DR subscale of Eating Disorder Examination Questionnaire (EDE-Q); EDE-Q items were modified to allow participants to explain why they restricted. Analyses included participants (N = 259) who responded to one of the modified EDE-Q questions. Results indicated that participants engaged in DR for several reasons, including minimizing the effect of hunger for other family members (i.e., children), "stretching" food to make it last longer, and prioritizing medical expenses. Intentional efforts to limit food intake in this sample were correlated with increased ED pathology. Although it is not surprising that adults experiencing food insecurity engage in intentional DR, this study adds important information about why food insecure adults engage in DR and highlights the importance of assessing DR for reasons other than weight and shape concerns.

Fat talk is predicted by body dissatisfaction and social comparison with no interaction effect: Evidence from two replication studies

Verbal denigration of personal body size and shape ("fat talk") is correlated with, and can have a causal influence on body dissatisfaction and disordered eating. What is less clear is who is most likely to fat talk. To address this, Corning and Gondoli (2012) conducted a study confirming that a woman's body dissatisfaction directly predicted their fat talk. But this effect was scaled so that the likelihood of engaging in fat talk intensified if she had a stronger tendency to socially compare: the relationship was multiplicative. Here, we carried out two replications of Corning and Gondoli's (2012) study, the first with 189 UK participants and the second with 371 US participants. We found that multiple regression models predicting fat talk showed additive, but not multiplicative relationships. A robust Bayesian meta-analysis combining the results of our two studies with the results of the original study confirmed this. In conclusion, these studies show an additive relationship between fat talk and social comparison on fat talk.

Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents

OBJECTIVE

Little research has investigated variables affecting the relationship between weight- or shape-related bullying (WSB) and specific forms of disordered eating in adolescence. This study aimed to examine the relationship between WSB and eating disorder behaviors in Australian adolescents, and whether this relationship was moderated by body image attitudes.

METHOD

Data were used from the first wave of the EveryBODY study, a survey of body image concerns and eating disorders in a large representative sample of Australian adolescents (N = 573), aged 11-19 years. Participants completed an online survey with measures of WSB frequency, body image attitudes (drives for thinness, leanness, and muscularity), and disordered eating behaviors.

RESULTS

Results indicated that frequency of WSB was positively associated with purging and muscularity-oriented behavior (MOB), but not dietary restriction, binge eating, or compulsive exercise. The relationship between WSB and MOB was moderated by drive for muscularity, such that victimization frequency was positively associated with MOB for those with high, but not low, desire to attain a muscular physique.

DISCUSSION

Findings indicate that WSB is positively associated with purging and MOB but not other eating disorder behaviors, and that drive for muscularity moderates its effect on some behaviors. Understanding these relationships will be important in implementing tailored interventions for adolescents based on screening for victimization experiences and specific body image attitudes.

The Relationship Between SNS Usage and Disordered Eating Behaviors: A Meta-Analysis

Social Networking Sites (SNSs) are common tools with which modern people share their lives and establish social relationships. However, some studies have found SNSs to be associated with eating disorders, although other have identified no connection between the two. To explore the interaction between SNSs and eating disorder behaviors, this study aimed to comprehensively synthesize previous studies using meta-analysis methods. Based on selection criteria, there were 87 effect sizes from 22 studies. After analysis using a three-level random-effects meta-analysis model, a positive correlation between the use of SNSs and irregular eating behaviors was found, r = 0.09 (95% CI: 0.06, 0.11; p < 0.001). In addition, by analyzing potential moderators, body mass index (r = -0.032; 95% CI: -0.058, -0.006; p = 0.019), survey methods, and sample sources was discovered could alter the relationship between SNSs and disordered eating behaviors. Specifically, there was a significantly larger association between SNSs results obtained by paper and pencil surveys and disordered eating behaviors (r = 0.114; 95% CI: 0.081, 0.147; p < 0.001) than that between SNSs results obtained by online surveys and disordered eating behaviors (r = -0.055; 95% CI: -0.102, -0.007; p < 0.01). University students showed a larger correlation between SNSs and disordered eating behavior than other samples (r = 0.089; 95% CI: 0.049, 0.129; p < 0.001). Overall, this meta-analysis confirms that the excessive use of SNSs is associated with an increased risks of disordered eating behaviors. It is hoped that this study can provide a reference for the management and intervention of dietary behaviors related to social networks in the future.

Factors that predict persistence versus non-persistence of eating disorder Symptoms: A prospective study of high-risk young women

Investigate baseline factors that prospectively predict persistence versus non-persistence of behavioral and cognitive eating disorder symptoms because knowledge of maintenance factors, which is limited, could inform the design of more effective eating disorder treatments. Data from 4 prevention trials that targeted young women with body image concerns (N = 1952; M age 19.7, SD 5.7) and collected interview-assessed data on behavioral and cognitive symptoms over 1-year follow-up were combined to address this aim. Greater binge eating severity predicted binge eating persistence. Greater dieting, binge eating frequency and severity, weight/shape overvaluation, and feeling fat predicted compensatory behavior persistence. Lower BMI predicted low BMI persistence. Greater thin-ideal internalization, body dissatisfaction, dieting, negative affect, binge eating frequency, binge eating severity, compensatory behaviors, weight/shape overvaluation, fear of fatness or weight gain, and feeling fat predicted weight/shape overvaluation persistence. Greater thin-ideal internalization, dieting, compensatory behaviors, weight/shape overvaluation, fear of fatness or weight gain, and feeling fat predicted persistence of fear of fatness or weight gain. Results provide support for intervention targets of several extant eating disorder treatments and identified novel maintenance factors not commonly targeted in treatments (e.g., negative affect). Results also imply that certain features of eating disorders predict symptom persistence.

Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems

The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ² = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.

Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men

OBJECTIVES

There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men.

METHOD

Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology.

RESULTS

Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation.

CONCLUSION

Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.

A test of the tripartite influence model of disordered eating among men

Studies of the Tripartite Influence Model conducted with female samples suggest that thinness-oriented pressures, internalization, and appearance comparisons may be risk factors for disordered eating. However, limited work has investigated this model among men utilizing measures specifically designed to assess both muscularity- and thinness-oriented processes, which characterize male body image concerns. To address this gap, the current study examined the Tripartite Influence Model of disordered eating among men using a battery of such measures. A convenience sample of 265 male undergraduates completed validated, self-report measures of disordered eating, muscularity- and thinness-oriented appearance pressures, internalization, and appearance comparisons. Path analyses supported a slightly modified version of the Tripartite Influence Model, indicating direct and indirect paths from sociocultural pressures to disordered eating via internalization and appearance comparisons. These results provide support for a version of the Tripartite Influence Model among men. Specifically, muscularity- and thinness-oriented pressures appear to be related to disordered eating among college men via indirect pathways involving thin internalization, muscular internalization, and appearance comparisons. Future work is needed, however, to examine whether the model would generalize to muscularity-oriented disordered eating.

Effects of caloric restriction on human physiological, psychological, and behavioral outcomes: highlights from CALERIE phase 2

Caloric restriction (CR) is a strategy that attenuates aging in multiple nonhuman species. The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trials are part of a research program aiming to test the effects of CR on aging and longevity biomarkers in humans. Building on CALERIE phase 1, CALERIE phase 2 (CALERIE 2) was the largest study to date to assess sustained CR in healthy humans without obesity. In a 24-month randomized controlled trial comprising 218 participants at baseline, CALERIE 2 showed that moderate CR, 11.9% on average, induced improvements in aging-related biomarkers without adversely affecting psychological or behavioral outcomes. The objectives of this report are to summarize and review the highlights of CALERIE 2 and report previously unpublished results on eating disorder symptoms and cognitive function. This article specifically summarizes the physiological, psychological, aging, behavioral, and safety results of the trial. Also provided are research directions beyond CALERIE 2 that highlight important opportunities to investigate the role of CR in aging, longevity, and health span in humans.

Strong is the New Skinny, but is it Ideal?: A Test of the Tripartite Influence Model using a new Measure of Fit-Ideal Internalisation

Although the thin body ideal has been the epitome of western female beauty for decades, the more recent fit body ideal is becoming arguably more popular. This study aimed to test two versions of the tripartite influence model (TIM; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999): one that included thin-ideal internalisation, and one that included fit-ideal internalisation, using path analysis. Participants were 558 Australian women aged 16-50 years (M = 22.06, SD = 7.41). All of the hypothesised paths were significant for both the thin- and fit-ideal internalisation models. The final models for both thin- and fit-ideal internalisation included extra, non-hypothesised paths from media to body dissatisfaction, and from social comparison to dieting, bulimic symptoms, and compulsive exercise. The two models differed in that the final model for thin-ideal internalisation included direct paths from thin-ideal internalisation to dieting and bulimic symptoms. The final model for fit-ideal internalisation, however, included a direct path from fit-ideal internalisation to compulsive exercise. It was concluded that, in contrast to the widely held perception that the fit ideal is a 'healthier' alternative to the thin ideal, fit ideal internalisation may be detrimental to female body satisfaction, disordered eating, and compulsive exercise.

Female Athletes in Retirement: A Test of a Psychosocial Model of Bulimic Symptomatology

Although researchers have examined eating disorders in female athletes, few such studies have been done with athletes who are retired, and even fewer have been quantitative. Thus, the authors empirically tested an established eating disorder theoretical model with 218 former NCAA Division-I female collegiate athletes who had been retired for 2-6 years. In retirement, participants completed measures of general sociocultural pressures related to body and appearance, thin-ideal internalization, body dissatisfaction, dietary restraint, negative affect, and bulimic symptomatology. Through structural equation modeling, the authors examined the direct and indirect relationships among the latent variables while controlling for body mass index and years since retirement. The model fit the data well, supporting the hypothesized direct and indirect relationships among the variables and explaining 54% of the variance in bulimic symptomatology. Despite no longer being exposed to sport pressures that contribute to eating disorders, female athletes experience such symptoms long into retirement.

Reexamining the restraint pathway as a conditional process among adolescent girls: When does dieting link body dissatisfaction to bulimia?

The mediational sequence from body dissatisfaction through dieting to bulimia-often referred to as the "restraint pathway"-has been validated in numerous samples of adolescent girls, but the prevalence rate of bulimic pathology pales in comparison to rates of body dissatisfaction and dieting in this risk group. This discrepancy indicates that the restraint pathway may only apply to adolescent girls possessing certain characteristics or experiencing certain circumstances. Accordingly, the current study examined the moderating roles of thin-ideal internalization, interoceptive deficits, and age by using self-report data from a community sample of 353 middle school (n = 115), high school (n = 112), and college girls (n = 126). We found that (a) body-dissatisfied girls who reported high, versus low, thin-ideal internalization engaged in greater dietary restraint; (b) only dieters who reported high interoceptive deficits and were of college age expressed bulimic symptoms; and (c) the mediating effect pertained only to college girls with high interoceptive deficits, but was strongest for those who reported high, versus low, thin-ideal internalization. These results suggest that the restraint pathway's precision may be fine-tuned through greater sensitivity to potentiating factors and developmental context. Theoretical, empirical, and practical implications are discussed.