Interpersonal and intrapersonal links to body appreciation in college women: an exploratory model

A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours

Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate 'health-centric' eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). There were 298 outcomes identified for body composition, size, and physical health (n = 116), mental health and wellbeing (n = 123), health promoting behaviours (n = 51) and other eating behaviour (n = 8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Our results demonstrate that 'health-centric' eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. These findings help to enhance our understanding of eating behaviours that do not centre around body weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.

Motivation to regulate eating behaviors, intuitive eating, and well-being: A dyadic study with mothers and adult daughters

Intuitive eating, defined as relying on physiological cues to determine when, what, and how much to eat while maintaining a positive relationship with food (Tribole & Resch, 1995), has gained a lot of research attention in the last two decades. The present study sought to determine how motivation for regulating eating behaviors is related to intuitive eating and well-being outcomes in dyads of mothers and their adult daughters (n = 214). Structural equation modelling revealed that controlling for dieting and desire to lose weight, both mothers' and daughters' autonomous motivation was positively associated with their own intuitive eating while their controlled motivation was negatively associated with intuitive eating. In turn, intuitive eating was positively associated with well-being in both mothers and daughters. Interestingly, mothers' intuitive eating was also positively related to their daughters' well-being. The analysis of indirect effects suggests that mothers' motivation to regulate eating behaviors has an indirect (mediating) relationship with daughters' well-being through mothers' intuitive eating. The implications for women's health and well-being are discussed.

Examining body appreciation in six countries: The impact of age and sociocultural pressure

Previous research on body appreciation across the lifespan has produced conflicting results that it increases with age, decreases with age, or is generally stable with an increase in women over 50-years-old. Furthermore, most of the research has been conducted in White, Western populations. Cross-cultural research suggests that both Chinese and African women experience similar sociocultural pressures as White Western women, and that appearance ideals are shifting to resemble a more Western ideal. We cross-sectionally and cross-culturally examined body appreciation across the lifespan, recruiting White Western women (UK, USA, Canada, and Australia), Black Nigerian women, and Chinese women. 1186 women aged 18-80 completed measures of body appreciation, internalisation of thin and athletic ideals, and perceived sociocultural pressure. Body appreciation did not vary with age in women from any country. Nigerian women reported the highest body appreciation, and Western women the lowest. Higher thin/athletic ideal internalisation, and higher perceived sociocultural pressure were significantly associated with lower body appreciation in all countries and age-groups. Overall, our findings indicate that although levels of body appreciation differ drastically between ethnicities and cultures, it is generally stable across age, and shows cross-culturally robust relationships between sociocultural internalisation and pressure.

Intuitive eating was associated with anxiety, depression, pregnancy weight and blood glucose in women with gestational diabetes mellitus: a prospective longitudinal study

Background

Outside of pregnancy, intuitive eating (IE) is associated with lower body weight, blood glucose, and higher positive mood. However, little was known about the relationship between IE and anxiety-depression in the GDM population. Thus, this study aimed to investigate the association of IE with anxiety and depression, pregnancy weight and pregnancy blood glucose in the first and second GDM visit.

Methods

Data from 310 pregnant women with GDM from the Fujian Maternal and Child Health Hospital Trial (Approval Number: 2020Y9133) were analyzed. IE was assessed using the Intuitive Eating Scale-2 subscales of Eating for Physiological Reasons rather than Emotional Reasons (EPR), Relying on Hunger and Satiety Cues (RHSC) and Body-Food Choice Consistency (B-FCC). Observations included weight, body mass index (BMI), fasting plasma glucose (FPG) and 2-h postprandial blood glucose; the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in pregnant women with GDM. Linear regression analysis was used to assess the correlation between IE and anxiety, depression, pregnancy blood glucose and weight.

Results

The cross-sectional analysis showed that the EPR eating behavior was negatively correlated with anxiety and depression, and the B-FCC eating behavior was negatively correlated with depression at both the first and second GDM visit; in addition, the B-FCC eating behavior was associated with lower BMI in the third trimester (all p < 0.05). In longitudinal analyses, the EPR eating behavior in the first visit for GDM predicted lower levels of anxiety and depression in the second GDM visit, whereas the RHSC eating behavior in the first visit for GDM was associated with lower FPG in the second GDM visit (all p < 0.01).

Conclusion

These results suggest that practicing intuitive eating may be beneficial and that higher intuitive eating adherence can lead to lower levels of anxiety and depression and more ideal gestational weight and blood glucose values.

Body appreciation and mindful eating in Lebanese adults: the mediating role of psychological distress

A gap in the literature exists about the associations between adaptive eating patterns like mindful eating, body appreciation and psychological distress within the Lebanese population. The current culture of acceptance and increased emphasis on wellbeing elicits interest in studying body acceptance and its correlates. The aim of the current study is to assess the mediating effect of psychological distress in the association between body appreciation and mindful eating behaviors among a sample of Lebanese adults. This cross-sectional study enrolled 465 participants. Men and women over the age of 18 were eligible to participate. Then, initial participants were asked to recruit other participants they know. Individuals who consented took an online questionnaire that contained the following scales: a section collecting sociodemographic information, Mindful Eating Behavior Scale, Depression Stress Anxiety Scale (DASS-8) and Body Appreciation (BAS-2). The results of the mediation analysis showed that psychological distress fully mediated the associations between body appreciation and eating with awareness/eating without distraction. Higher body appreciation was significantly associated with less psychological distress, whereas higher psychological distress was significantly associated with less eating with awareness/eating without distraction. However, body appreciation was not associated with eating with awareness/eating without distraction respectively. These findings could guide further research on different categories of adaptive eating patterns and positive body variables within the Lebanese population.

Positive self-beliefs mediate the association between body appreciation and positive mental health

Previous work has supported direct, positive associations between body appreciation and positive mental health, but has largely neglected to examine possible indirect mechanistic pathways. Here, we propose one relevant mediational pathway, wherein body appreciation is associated with positive mental health via positive self-beliefs (i.e., cognitions that lead individuals to view themselves, their lives, and/or their futures under a positive outlook). To test this hypothesis, we asked an online sample of 496 adults (249 women, 247 men) from the United Kingdom to complete measures of body appreciation, positive self-beliefs, and positive mental health. Participants also completed measures of self-efficacy and resilience, and provided their demographic information. Correlational analysis revealed significant, positive, and strong associations between body appreciation and facets of positive self-beliefs and positive mental health, respectively. Structural equation modelling showed that positive self-beliefs mediated the association between body appreciation and positive mental health after controlling for self-efficacy and resilience. This model was robust across women and men separately, and the mediational effects remained intact in sensitivity and robustness analyses. We discuss ways in which greater body appreciation may help individuals develop and maintain positive self-beliefs, which in turn shape mental health outcomes.

Efficacy of body appreciation training on body image concerns in overweight adolescents

Body image concern is one of the important issues in the field of overweight and the factors of failure in losing weight which is necessary to undergo intervention to increase the efficiency of sports and nutrition programs. This study aimed to analyze the efficacy of body appreciation training on body image concerns in overweight adolescents. It was a semi-experimental method with a pre-test and post-test design with a control group). The research community consisted of overweight girl adolescents who were referred to weight control and weight loss centers in Isfahan City in 2021. From the mentioned society, 30 adolescents were selected by targeted sampling method and assigned to two groups of 15 people, experiment and control. The experimental group received 9 sessions of 90-min body appreciation training. The control group was on the waiting list during this time. The research tool was the body image concern questionnaire of Littleton et al. (2005). Data analysis was done using SPSS-24 software and the covariance analysis method. The results showed that there is a significant difference between the two groups in the variable of concerns related to body image (P < 0.001); Also, the results showed that there is a significant difference between the two groups in the variables of dissatisfaction with appearance and interference in social functioning (P < 0.001). In this way, based on the results of this research, body appreciation training can be used to reduce concerns related to body image in overweight adolescents.

Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

Primary and Secondary Psychopathic Traits: Investigating the Role of Attachment and Experiences of Shame

Primary and secondary psychopathic traits have been documented in the general population and previous research has shown their link to adult insecure attachment and shame. However, there has been a gap in the literature examining the specific role of attachment avoidance and anxiety, and experiences of shame in the expression of these psychopathic traits. This study aimed to explore the associations between the attachment dimensions of anxiety and avoidance, in addition to characterological, behavioral and body shame with primary and secondary psychopathic traits. A non-clinical sample of 293 adults (M age= 30.77, SD = 12.64; 34% males) was recruited and completed an online battery of questionnaires. Hierarchical regression analyses indicated that demographic variables (age and gender) explained the largest variance for primary psychopathic traits, while the attachment dimensions (anxiety and avoidance) explaining the largest variance for secondary psychopathic traits. Characterological shame had a direct and indirect effect on both primary and secondary psychopathic traits. The findings highlight the need to examine psychopathic traits in community samples as a multidimensional construct, with a particular focus on also assessing attachment dimensions and shame subtypes.

Enriching sociocultural perspectives on the effects of idealized body norms: Integrating shame, positive body image, and self-compassion

Body image is an integral aspect of the psychology of the self. Idealized body images are ubiquitous in both traditional media forms (e.g., magazines, television) and social media (e.g., Facebook, Instagram). The classic sociocultural model of body image (i.e., the Tripartite Influence Model) emphasizes pathways between idealized body norms, appearance comparisons, internalization of body ideals, and body dissatisfaction and its outcomes. We summarize the model and identify some issues to be addressed in future work, particularly in light of the immense popularity of social media. We review three topics that are not included in the sociocultural model but that provide a more complete picture of the influence of societal body norms on body image: (1) body shame, (2) positive body image, and (3) self-compassion. Research on the nature, assessment, and relevance of these constructs is reviewed in detail. In terms of clinical applications of these areas of research for individuals at risk of body dissatisfaction, we suggest assessing for and targeting body shame, cultivating facets of positive body image, and teaching strategies for developing self-compassion.

The effects of body-positive Instagram posts on body image in adult women

While recent studies have examined the effects of viewing body-positive social media content on body appreciation and satisfaction in young adult women, research has yet to include older adult women. The current study assessed the effects of viewing body-positive Instagram content on body image in 205 adult women (18-76 years old) who were randomly assigned to view either body-positive, thin-ideal, or appearance-neutral Instagram content. Our findings demonstrated that exposure to body-positive Instagram content resulted in greater levels of body appreciation and body satisfaction compared to exposure to thin-ideal and neutral Instagram content, while no significant differences were found between any of the conditions on self-objectification. Finally, age was only a significant moderator for one variable (self objectification) and condition (thin ideal), indicating that exposure to body-positive social media content may improve levels of body appreciation and satisfaction in adult women, regardless of age.

Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction

PURPOSE

Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction.

METHODS

Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups.

RESULTS

The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post-intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60).

CONCLUSION

Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem.

LEVEL OF EVIDENCE

Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/ ) number of registration: RBR-2f57cs. Date of registration: June 1, 2020.

Gender Differences in Body Appreciation and Its Associations With Psychiatric Symptoms Among Chinese College Students: A Nationwide Survey

BACKGROUND

Body appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China.

METHOD

This cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively.

RESULTS

In total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F _(1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = -0.129, P < 0.001; anxiety symptoms, β = -0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = -0.172, P < 0.001; anxiety symptoms, β = -0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men.

CONCLUSION

Chinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.

Modeling the associations between internal body orientation, body appreciation, and intuitive eating among early-adult and middle-adult men and women: A multigroup structural invariance analysis

This cross-sectional study investigated the associations among internal body orientation, body appreciation, intuitive eating, age, and BMI in men and women between 30 and 70 years old as delineated in the acceptance model of intuitive eating. Self-report measures were administered to a final sample of 522 individuals consisting of early-adult men (ages 30-44; n = 153), middle-adult men (ages 45-70; n = 108), early-adult women (ages 30-44; n = 135), and middle-adult women (ages 45-70; n = 126). Overall mean age was 45.03 (SD = 10.95). Structural equation modeling evidenced that, for both age groups of men and women, internal body orientation was positively associated with body appreciation and body appreciation was positively associated with intuitive eating. Internal body orientation was positively associated with intuitive eating in each group, except early-adult women. The associations among age and BMI with the aforementioned variables were inconsistent. Although evidencing measurement non-invariance among a number of parameters, multigroup structural invariance analyses showed that the associations among internal body orientation, body appreciation, intuitive eating, age, and BMI were invariant across each gender and age. These results further confirm components of the acceptance model of intuitive eating among men and women in early-adulthood and middle-adulthood.

Self-Compassion as a Mediator of the Relationship between Adult Women's Attachment and Intuitive Eating

Despite growing interest in intuitive eating-a non-dieting approach to eating that is based on feeding the body in accordance with physiological and satiety cues-research on its determinants is scarce. The present study aimed to examine the associations between dimensions of adult attachment (i.e., anxiety and avoidance) and intuitive eating, and the mediating role of self-compassion in these relationships. The sample comprised 201 French-Canadian young adult women (M = 25.1, SD = 4.6). Participants completed self-report questionnaires through an online survey. Results of the structural equation model demonstrated that attachment-related anxiety and avoidance were negatively associated with intuitive eating, and these relationships were at least partially mediated by self-compassion. Findings suggest that women who have high levels of attachment anxiety or avoidance engage in less intuitive eating partly because they are less self-compassionate. Results highlight the importance of self-compassion in facilitating adaptive eating behaviors in adult women, especially if they have an insecure attachment style to romantic partners.

Focus on the Beauty of Body: The Mediation Role of Body Appreciation Between Perfectionism and Body-Related Shame and Body-Related Guilt

Objectives: According to traditional views, perfectionists are prone to experience shame and guilt. As a relative part of negative body image, body appreciation reflects an appreciation attitude toward physical characteristics, functionality, and health, accepting and appreciating all parts and functions of the body, predicting body-related shame and guilt. Methods: Therefore, body appreciation was examined for its potential mediating role in the relationship between two dimensions of perfectionism (e.g., healthy perfectionism and unhealthy perfectionism) and body-related shame and body-related guilt among 514 females. Results: The results highlight that body appreciation partially mediated the relationship between perfectionism and body-related shame and body-related guilt. Implications for enhancing body appreciation among females between experiencing healthy or unhealthy perfectionism and body-related shame and body-related guilt feelings are discussed. Conclusions: These findings underscore the importance of considering body appreciation in addressing perfectionism dimensions and body-related shame and body-related guilt. Research and clinical implications are also addressed.

Intuitive eating and its psychological correlates: A meta-analysis

OBJECTIVE

Intuitive eating is an adaptive style of eating that has generated significant research attention. Theoretically, intuitive eating is a core construct that features prominently in the Acceptance Model of Intuitive Eating, a framework that explains how positive environmental influences can foster intuitive eating practices via body appreciation. Empirically, intuitive eating has been connected to a broad range of adaptive mental health indices. At present, a quantitative synthesis of intuitive eating and its correlates has yet to be conducted. This was the objective of the current meta-analysis.

METHOD

Ninety-seven studies (89% cross-sectional) were included. Random effects meta-analyses were conducted on 23 psychological correlates, divided into three clusters: eating behavior and body image disturbances, positive body image and other adaptive factors, and general psychopathology. Meta-analytic path analyses were also computed to test the validity of the Acceptance Model.

RESULTS

Intuitive eating was inversely associated with multiple indices of eating pathology, body image disturbances, and psychopathology (rs = -.23 to -.58). Intuitive eating was positively associated with numerous positive psychological constructs, such as positive body image, self-esteem, and wellbeing (rs = .20 to .58). Men reported higher levels of intuitive eating than women (d = 0.39), with differences being largest in Caucasian samples. Meta-analytic path analyses strongly supported the hypothesized pathways specified in the Acceptance Model of Intuitive Eating.

CONCLUSIONS

There is a strong evidence base for intuitive eating's connection to numerous adaptive psychological constructs. Attention should now shift toward prospective and experimental designs so that the temporal nature of these relationships can be identified.

Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010-2018

PURPOSE

To examine longitudinal associations of intuitive eating (IE), defined as eating according to internal hunger and satiety cues, with psychological health outcomes and disordered eating behaviors.

METHODS

Data from a diverse sample of 1491 participants (54.1% female, 19.7% non-Hispanic white) followed from adolescence (baseline; M_age= 14.5 years) into young adulthood (follow-up; M_age = 22.2 years) came from the population-based EAT 2010-2018 (Eating and Activity over Time) study. Logistic regression models predicting psychological health outcomes and disordered eating behaviors at follow-up simultaneously included baseline IE and change in IE from baseline to follow-up as predictors, adjusting for demographic covariates, body mass index, and outcome at baseline.

RESULTS

Greater baseline IE and increases in IE from baseline to follow-up were both associated with lower odds of high depressive symptoms, low self-esteem, high body dissatisfaction, unhealthy weight control behaviors (e.g., fasting, skipping meals), extreme weight control behaviors (e.g., taking diet pills, vomiting), and binge eating at 8-year follow-up. Particularly strong protective associations were observed for binge eating, such that a one-point higher IE score at baseline was associated with 74% lower odds of binge eating at follow-up, and a one-point higher increase in IE score from baseline to follow-up was associated with 71% lower odds of binge eating at follow-up.

CONCLUSIONS

These results indicate that IE longitudinally predicts better psychological and behavioral health across a range of outcomes and suggest that IE may be a valuable intervention target for improving psychological health and reducing disordered eating behaviors, particularly binge eating.

LEVEL OF EVIDENCE

Level III, cohort study.

Appearance Comparisons and Eating Pathology: A Moderated Serial Mediation Analysis Exploring Body Image Flexibility and Body Appreciation as Mediators and Self-Compassion as Moderator

Comparing one's body against the bodies of others is related to lower positive body image and higher eating pathology. Underlying mechanisms as well as protective factors of these relationships are yet to be discovered. The present study examined body image flexibility and body appreciation as potential mediators of the association between appearance comparisons and eating disorder psychopathology. Additionally, it was tested whether self-compassion moderates the mediation effects. In an online sample comprising 250 women (M_age = 42.66, SD = 12.24), the inverse relationship between appearance comparisons and body appreciation was mediated by body image flexibility and the positive relationship between appearance comparisons and eating disorder psychopathology was mediated by body image flexibility and serially mediated by body image flexibility and body appreciation, when controlling for body mass index and age. Simple mediations were further moderated by self-compassion, such that indirect effects were attenuated at high levels of self-compassion. Promoting body image flexibility may be one potential target for helping women to engage in less maladaptive and more adaptive ways of treating the body when comparing one's appearance. Building self-compassion may be another potential target that may protect body image flexibility and its correlates in the face of appearance comparisons.

The association between body appreciation and body mass index among males and females: A meta-analysis

To date, a number of studies have reported an association between body appreciation and body mass index (BMI), but the findings are not consistent. Using a meta-analytic approach, the current study aimed to clarify this association as well as to explore what factors might have contributed to the inconsistency across previous studies. By searching and screening potential studies published up to June 2019 in four databases, we identified 26 articles that reported an association between body appreciation and BMI among males, and 59 articles among females. Under a random-effects model, among males the overall estimate of the association between body appreciation and BMI was negative and small, with the pooled r = -.20 (95 % CI: -.25, -.14) and an adjusted (for publication bias) pooled r = -.11 (95 % CI: -.16, -.06). Among females, the overall estimate of the association was negative and small (but close to moderate), with r = -.27 (95 % CI: -.30, -.24). A mixed-effects model identified several moderators that contributed to the inconsistency across previous studies. These results indicate that the overall negative association between body appreciation and BMI is weak among males, and slightly larger among females. Potential explanations, implications, and future research directions are discussed.

Drive For Muscularity in Male Adolescents: The Role of Psychological Factors (Self-Esteem, Maladaptive Perfectionism, and Interpersonal Sensitivity)

Background: Concerns about body image among male adolescents has become increasingly prevalent, leading to a need for muscularity. It is well known that psychological factors play a role in the development of these concerns. Objectives: The aim of the current study was to predict the drive for muscularity based on psychological factors, including self-esteem, maladaptive perfectionism, and interpersonal sensitivity. Methods: This cross-sectional study was conducted in 2019. Using a convenience sampling method, 150 adolescent male students from district 14 of Tehran, Iran, were selected to participate in the study. Data was collected by utilizing the following measures: drive for Muscularity scale, Rosenberg Self-Esteem scale, Almost Perfect scale-revised, and Interpersonal Sensitivity measure. Data were analyzed using the Pearson correlation coefficient and the Enter Regression method. Results: High scores in the Drive for Muscularity scale were significantly associated with higher levels of maladaptive perfectionism, interpersonal sensitivity, and lower levels of self-esteem. Moreover, the results of the multiple regression analysis revealed that predivariables could explain 52% in the variance of the drive for muscularity. Conclusions: Findings indicated that the psychological factors investigated in this study were risk factors for masculinity among adolescents. We suggest that clinicians take these factors into account in order to make preventive and therapeutic programs more effective.

Self-to-others and self-to-self relationships: paths to understanding the valence of body image and eating attitudes in emerging adult women

PURPOSE

Interpersonal and intrapersonal factors contributing to body appreciation in emerging adult women remain poorly explored. Thus, the present study aimed to test the impact of early memories of warmth and safeness with peers, self-compassion, and social safeness, in body appreciation and in disordered eating attitudes and behaviours.

METHODS

A total of 387 women aged between 18 and 25 completed a set of self-report questionnaires. Data were analysed through descriptive and correlation statistics, and the suitability of a theoretical model was explored via path analysis. Self-report instruments assessed participants' weight and height, early memories of warmth and safeness with peers, self-compassion, social safeness, body appreciation, as well as disordered eating.

RESULTS

Early memories of warmth and safeness with peers associated with higher self-compassion and feelings of social safeness, which were both positively linked to body appreciation. Body appreciation associated with a lower display of disordered eating.

CONCLUSION

It seems that childhood and adolescent experiences may have an important influence on the development of self-to-self and self-to-others secure relationships, with consequences on the way women behave and relate with their unique body characteristics. The pertinence of developing self-compassion and affiliative skills to promote positive body image among females is suggested, as well as of applying compassion-based strategies when clinically approaching symptoms of eating disorders.

LEVEL OF EVIDENCE

Cross-sectional descriptive study, Level V.

An investigation of the association between body appreciation, need for self-expression, and interest in cosmetic enhancing procedures

PURPOSE

To examine the association between body appreciation and three factors reflective of individuals' need for self-expression: uniqueness, investment in a distinctive appearance, and interest in cosmetic enhancements.

DESIGN AND METHODS

Cross-sectional, correlational design. Participants (N = 256) completed measurements of body appreciation, interest in cosmetic enhancements, need for uniqueness, and investment in a distinctive appearance.

FINDINGS

Body appreciation was associated with the need for uniqueness and a distinctive appearance investment. Only a generalized need for uniqueness was associated with a greater tendency to use cosmetic enhancing procedures.

IMPLICATIONS

Body appreciation appears to be related to established markers of positive striving for uniqueness. Thus, the use of cosmetic enhancements may serve to promote a unique sense of self and, potentially, a more positive body image.

The soothing-affiliation system and body appreciation: recollected and present affect

Attachment and affiliation-related affect has been stated to be a powerful regulator of human development, maturation, well-being and health. Accordingly, as research on positive body image has evolved, data on the association between non-judgmental interpersonal relationships and body appreciation has emerged. The present study sought to explore a model linking memories of early affiliative relationships with body appreciation via higher current social safeness and the experience of positive affect in a sample of Portuguese women aged between 18 and 50 years (N = 286). Online data collection occurred throughout 2017. The multivariate analyses of the hypothesized model revealed good fit to the data, and results showed that early memories of warmth and safeness were associated with body appreciation via higher current social safeness and higher safeness/contentment affect. Safeness/contentment affect was the positive affect revealed as being more strongly related to body appreciation. These results provide strong support for the importance of early and current emotional bonds for women's body appreciation and suggest that therapists should consider the cultivation of affiliation skills when promoting positive body image.

"No seconds for you!": Exploring a sociocultural model of fat-talking in the presence of family involving restrictive/critical caregiver eating messages, relational body image, and anti-fat attitudes in college women

In line with sociocultural models of parental influence on body image, we examined the relationship between recall of restrictive/critical caregiver eating messages (RCEM) and current frequency of disclosing self-disparaging fat talk among family in 335 undergraduate women (M_age = 19.4; SD = 1.53; range = 18-27). Additionally, two forms of relational body image (i.e., perceived body acceptance by others, external body image shame) and anti-fat attitudes were tested as potential explanatory pathways. RCEM were positively related to current frequency of self-directed fat talk in the family context. All three proposed mediators helped explain this relationship, with external body image shame demonstrating the largest observed effect. Findings suggest frequent recollections of caregivers' implied weight-stigmatizing comments surrounding eating may contribute to more frequent self-denigrating body talk with family members at present via both positive and negative dimensions of relational body image and endorsed explicit weight bias. Theoretical and practical implications are discussed.

Body appreciation and body-related pride in normal-weight and overweight/obese individuals: Does romantic relationship matter?

PURPOSE

The study investigated body appreciation and body-related pride in normal-weight and overweight/obese individuals. A question of whether romantic relationship differentiates body image in these groups was also asked.

DESIGN AND METHODS

Measures of body appreciation, body-related pride, self-esteem, and positive affect were administered in a sample of 344 subjects.

FINDINGS

Participants with normal weight reported higher body appreciation and body-related pride. The analysis revealed that there were no differences in body image between normal-weight and overweight/obese individuals who were in a romantic relationship.

PRACTICE IMPLICATIONS

The study provides a better understanding of factors related to an individual's body image.

Psychological Effects of the SRS-22 on Girls With Adolescent Idiopathic Scoliosis

STUDY DESIGN

Prospective, randomized control study.

OBJECTIVES

To determine whether the SRS-22r (SRS-22) has a negative effect on the body image of females with adolescent idiopathic scoliosis (AIS) using the Body Appreciation Scale (BAS).

SUMMARY

The SRS-22 is a validated questionnaire designed by the Scoliosis Research Society (SRS) to assess outcomes of scoliosis patients. Parents and nursing staff have expressed concern that the questionnaire may incite body image concerns when administered to teenagers with AIS.

METHODS

Female AIS patients were prospectively enrolled and randomly assigned to the study or control group. Patients were being observed, braced, or planning operative intervention. Patients in the study group were administered the SRS-22, followed by the BAS. Patients in the control group were administered only the BAS. The BAS is scored from 13 to 65, with higher scores indicating a more positive body image.

RESULTS

45 females were enrolled and assigned to study group (n = 24, SRS-22+BAS) or control group (n = 21, BAS only). There were no differences between the groups in age (p = .55) or Cobb angle (p = .21). There were no differences in overall BAS scores between study (mean = 55.9, range 31-65) and control group participants (mean = 54.2, range 42-64, p = .56). SRS-22 questions and BAS scores had multiple correlations. A higher BAS score is associated with the following SRS-22 questions: being a happy person in the last 6 months, feeling calm and peaceful during the past 6 months, and feeling attractive with one's current back condition. A lower BAS score is associated with the following SRS-22 questions: being down in the dumps, feeling downhearted and blue, and feeling that one's back condition affects personal relationships.

CONCLUSION

Similar BAS scores were observed between the study and control group. Despite concerns regarding the potential negative impact of the SRS-22, taking the questionnaire was not observed to negatively affect patients' body image.

LEVEL OF EVIDENCE

Level II.

The My Body Knows When Program Increased Intuitive Eating Characteristics in a Military Population

Introduction

The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode.

Materials and Methods

Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power).

Results

Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m2. There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (−0.4 ± 0.6 kg/m2; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; −0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; −0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects.

Conclusions

The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain).

Brazilian Version of the Body Appreciation Scale (BAS) for Young Adolescents

The present study developed a Brazilian adaptation of the BAS for young adolescents, testing its factor structure by the Confirmatory Factor Analysis (CFA), concurrent and criterion validity, and its internal consistency. Participants were 347 adolescents (171 male and 176 female, aged between 10 and 13 years old). Three psychologists experts in psychological evaluation and three teachers of Portuguese of elementary school also participated for the adaptation stage of the items in order to be properly understood by the sample age group. There were few changes from the version culturally adapted for the Brazilian adult population. Cronbach's alpha coefficients were satisfactory for the general population and both sexes (.804; female =.851; male =.752). The one-factor model of the BAS was confirmed by the confirmatory factor analysis with good indicators for the measurements of adjustment to the model, χ2 = 77.9; GFI = 0.967; NFI = 0.940, CFI = 0.979; TLI = 0.968; RMSEA;.038). The convergent validity analyzes revealed significant correlations between BAS scores and BMI (r = -.230; p < .001) and between the first and body image satisfaction (r = .309; p < .001). The BAS version for Brazilian young adolescents had adequate levels of validity and reliability, keeping the one-dimensional structure which indicates its use in Brazilian adolescent's samples.

Adolescent perfectionism: Structural features of the Frost Multidimensional Perfectionism Scale and correlates with attachment and psychopathology

OBJECTIVES

Perfectionism is recognized as a significant risk factor for psychopathology. Emerging research links attachment to perfectionism in adult and college-age samples. The Frost Multidimensional Perfectionism Scale (FMPS) has been used in adults and adolescents with a variety of factor structures found. This study sought to establish the factor structure in a general adolescent sample prior to testing for associations between perfectionism, attachment, and psychopathology in the same sample.

DESIGN

A cross-sectional survey design was used. Confirmatory factor analysis, and correlational and regression analyses were employed.

METHODS

A total of 290 adolescents, aged 12-18 years, were recruited from a state secondary school. All completed the FMPS along with brief measures of attachment and psychopathology.

RESULT

Exploratory and confirmatory factor analyses failed to replicate previously published models, and a new six-item, 1-factor model representing perfectionism was found instead. This new variable was then used to establish a role for perfectionism and attachment anxiety in predicting internalizing problems. Perfectionism also correlated with conduct problems and hyperactivity.

CONCLUSION

This study established a novel factor structure for the FMPS, allowing proof of principle of the role of perfectionism in a relationship with attachment and psychopathology, which after replication, may inform new interventions for perfectionism. Caution is noted about the use of extant perfectionism measures that are not properly developmentally informed and which do not capture the dynamic nature of adolescence and adolescent perfectionism.

PRACTITIONER POINTS

Perfectionism is a feature of adolescent psychopathology, including internalizing and externalizing problems. Perfectionism is associated with attachment anxiety and together contributes to internalizing problems. Current conceptualizations of perfectionism may not capture the specific developmental and dynamic aspects of adolescence and should not be regarded as a stable personality trait.

Adherence to Hunger Training over 6 Months and the Effect on Weight and Eating Behaviour: Secondary Analysis of a Randomised Controlled Trial

Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to 'hunger training' influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to 'hunger training', chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% (n = 36/50) at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days) lost 6.8 kg (95% CI: 2.6, 11.0; p < 0.001) more weight than those who completed fewer days. They also had significantly higher intuitive eating scores than those who completed 30 days or less of booklet entry; a difference (95% CI) of 0.73 (0.12, 1.35) in body-food choice congruence and 0.79 (0.06, 1.51) for eating for physical rather than emotional reasons. Adherent participants also reported significantly lower scores for emotional eating of -0.70 (-1.13, -0.27). Following hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour.

Body appreciation, interest in cosmetic enhancements, and need for uniqueness among U.S. college students

The aim of the current study was to examine associations between body appreciation and putative correlates that focus on self-enhancement and self-expression. Students (N=261; mean age=20.16years, SD=3.68; 60.9% female) from a non-residential college in the northeastern United States completed a questionnaire measuring body appreciation, interest in cosmetic enhancements, and need for uniqueness. Individuals with higher body appreciation and African Americans/Blacks reported significantly higher self-attributed need for uniqueness and significantly higher investment in a distinctive appearance. The association between body appreciation and interest in cosmetic enhancements (e.g., hair coloring) was not significant. Results suggest that body appreciation may be linked to a desire to express one's own unique qualities.

Addressing Concerns About How Perfectionistic Discrepancy Should Be Measured With the Revised Almost Perfect Scale

We examine the conceptual and empirical merits of concerns Flett et al. recently raised about the Almost Perfect Scale-Revised (APS-R), specifically that items on the APS-R Discrepancy should be separated into a "Pure" Discrepancy factor and a Dissatisfaction factor. Limitations in the logic and findings of that critique are summarized. We replicate and extend Flett et al.'s study with results from two samples: (a) college freshmen STEM students ( N = 279) and (b) doctoral students in a national sample ( N = 529). Confirmatory factor analyses indicated that the alternative measurement models could be fit to the data, but were not practical improvements over the original APS-R factor model: Alternative discrepancy factors failed to demonstrate discriminant validity, nor did they have meaningfully different patterns of associations with numerous criterion variables (i.e., stress, emotion regulation, rumination, adult attachment, and life satisfaction). Thus, a data-based answer to the question of how perfectionistic discrepancy should be assessed is to stay the course with confidence using the original APS-R.

Self-compassion as a mediator between attachment anxiety and body appreciation: An exploratory model

Body appreciation has been found to be linked to interpersonal and intrapersonal factors, with attachment styles and self-compassion separately identified as important correlates. The present study examined these variables together in a model, and we hypothesized that maternal attachment anxiety was related to peer and romantic attachment anxiety, which, in turn, was associated with self-compassion and body appreciation. Using structural equation modeling, this cross-sectional study with a sample of 1306 incoming first year college women found that the proposed model explained 40% of the variance in body appreciation. Results further revealed that peer and romantic attachment anxiety mediated the relationships between maternal attachment anxiety and self-compassion, and that self-compassion mediated the associations between peer and romantic attachment anxiety and body appreciation. Self-compassion appears to hold a central role in explaining the relation between attachment anxiety and body appreciation.

Exploring body appreciation and women's health-related quality of life: The moderating role of age

This study explored relationships between body appreciation, health-related quality of life, and age, in an age-diverse sample of 289 women in the United States. Linear regression indicated the relationship between body appreciation and the physical component of health-related quality of life varied by age. For women aged 36 years and older, there was a positive relationship between body appreciation and health-related quality of life; however, a negative relationship was present for other age groups. Findings have clinical implications and suggest body appreciation may buffer the decline in physical health-related quality of life that occurs as age increases.

Predicting body appreciation in young women: An integrated model of positive body image

This study examined a range of predictors, based on previous theoretical models, of positive body image in young adult women. Participants were 266 women who completed an online questionnaire measuring body appreciation, activity participation, media consumption, perceived body acceptance by others, self-compassion, and autonomy. Potential mechanisms in predicting body appreciation assessed were self-objectification, social appearance comparison, and thin-ideal internalisation. Results indicated that greater perceived body acceptance by others and self-compassion, and lower appearance media consumption, self-objectification, social comparison, and thin-ideal internalisation were related to greater body appreciation. An integrated model showed that appearance media (negatively) and non-appearance media and self-compassion (positively) were associated with lower self-objectification, social comparison, and thin-ideal internalisation, which in turn related to greater body appreciation. Additionally, perceived body acceptance by others was directly associated with body appreciation. The results contribute to an understanding of potential pathways of positive body image development, thereby highlighting possible intervention targets.

Eating- and weight-related factors associated with depressive symptoms in emerging adulthood

Research suggests that eating- and weight-related disturbances (EWRDs) are key factors associated with depressive symptoms. However, it is unclear how EWRDs, and to a greater extent body appreciation, are associated with depressive symptoms among emerging adults. This study investigated the association between EWRDs, body appreciation, and depressive symptoms among emerging adults. Female (n=473) and male (n=135) emerging adults completed measures of restrained eating, emotional eating, external eating, drive for muscularity, body appreciation, and depressive symptoms. Hierarchical multiple regression analyses, performed separately for women and men, found that restrained eating was significantly related to depressive symptoms among both genders, whereas emotional and external eating were significantly associated with depressive symptoms in women only. Body appreciation was negatively associated with depressive symptoms in both genders. The findings highlight the need for clinicians to assess for EWRDs and promote positive body appreciation among emerging adults.

Positive Body Image and Sexual Functioning in Dutch Female University Students: The Role of Adult Romantic Attachment

This study focused on links between romantic attachment, positive body image, and sexual functioning. Dutch female university students (N = 399) completed an online survey that included self-report items about body appreciation, sexual functioning, and romantic attachment. A proposed conceptual model was tested using structural equation modeling and a good fit to the data was found. Results revealed that attachment avoidance in a romantic context was negatively related to sexual arousal, vaginal lubrication, the ability to reach orgasm, and sexual satisfaction. Attachment anxiety was negatively related to body appreciation which, in turn, was positively related to sexual desire and arousal. Findings indicated that romantic attachment is meaningfully linked to body appreciation and sexual functioning. Therefore, the concept of adult attachment may be a useful tool for the treatment of sexual problems of young women.

Perceiving beauty in all women: Psychometric evaluation of the Broad Conceptualization of Beauty Scale

Women's ability to broadly conceptualize beauty (i.e., perceive many looks, appearances, body sizes/shapes, and inner characteristics as beautiful) has been identified as a facet of positive body image in qualitative research. A scale is needed to be able to assess this construct within quantitative research. Therefore, we developed the Broad Conceptualization of Beauty Scale (BCBS), which measures the extent women define female beauty widely within external and internal characteristics, and examined its psychometric properties among four community samples totaling 1086 women. Exploratory and confirmatory factor analyses revealed a unidimensional structure with nine items. The internal consistency, test-retest reliability, and construct (convergent, discriminant, and incremental) validity of its scores were upheld. Researchers and clinicians can use the BCBS alone to assess women's perceptions of female beauty, or they can use the BCBS alongside women's perceptions of self-beauty to more comprehensively explore women's ability to broadly conceptualize beauty for others and themselves.

Weight acceptance versus body dissatisfaction: Effects on stigma, perceived self-esteem, and perceived psychopathology

OBJECTIVE

It is unknown whether weight acceptance or body dissatisfaction impact anti-fat stigma. Therefore, this study utilized a 2×2 between-subject experimental design to examine of the relationship between body acceptance and stigmatization.

METHOD

Participants were university undergraduates (N=394, 70% women, mean age=20.8 years, mean BMI=23.61 kg/m(2)) who were randomly assigned to read vignettes describing an obese or normal-weight target described as either accepting or not accepting of her weight. Participants completed measures of stigma (the Fat Phobia Scale (FPS), the modified Anti-fat Attitudes Scale (AFA)), perceived self-esteem (assessed with the modified Rosenberg Self-Esteem Scale (RSE)), and perceived psychopathology.

RESULTS

Analyses revealed significant main effects for acceptance. Notably, targets who accepted their weight were less stigmatized on the FPS (F(1, 354)=66.82, p<.001) and the AFA willpower subscale (F(1, 373)=37.90, p<.001), and they were perceived as having better self esteem (F(1, 371)=166.16, p<.001) and fewer psychological problems (F(1, 381)=123.19, p<.001) than those who did not accept their weight.

CONCLUSION

Results from this study suggest that size acceptance, even when practiced by obese targets, was significantly less stigmatized than body dissatisfaction and associated with better perceived self esteem and mental health.

A systematic review of the psychosocial correlates of intuitive eating among adult women

Intuitive eating has been proposed as an eating style that fosters a positive attitude towards food, the body, and physical activity. A systematic review of the literature was undertaken to examine intuitive eating in relation to disordered eating, body image, emotional functioning, and other psychosocial correlates in adult women. Articles were identified through Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source (Nursing and Academic Edition), Medline Complete, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, PubMed and Scopus. Eligible studies were those that examined women aged 18 years and older, measured intuitive eating, and assessed a psychosocial correlate of intuitive eating. Twenty-four cross-sectional studies, published between 2006 and September 2015, met eligibility criteria. Intuitive eating was associated with less disordered eating, a more positive body image, greater emotional functioning, and a number of other psychosocial correlates that have been examined less extensively. However, given that all studies used cross-sectional designs, no conclusions regarding the direction of the relationship between intuitive eating and psychosocial correlates can be drawn. Participants in the majority of studies were university students in the United States so findings cannot be generalised to the wider population of female adults. Prospective studies are now needed to verify these cross-sectional findings, and show if intuitive eating may reduce disordered eating and body image concerns, and promote women's psychological health and well-being.

Gender differences in couple attachment behaviors as predictors of dietary habits and physical activity levels

This study used an Actor-Partner Interdependence Model to examine the relationship between attachment behaviors and health practices, as measured by physical activity levels and dietary habits. The sample included 1031 married couples, the majority of which is Caucasian (83.8%). Results suggest that women's attachment behaviors significantly influenced their own health practices (p = .038), such that for every unit increase in poor attachment behaviors, women were 199.8 percent more likely to have poor diet and low physical activity levels (exp(1.098) = 2.998). Men's attachment behaviors were not significantly related to their own health practices. There were also no significant partner paths. Implications for treating women who present with health problems are discussed, as are directions for future research.