Appearance comparison and other appearance-related influences on body dissatisfaction in everyday life

The Moderating Effect of Suggestibility on the Relationship between Body Mass Index and Body Dissatisfaction in Women

Background: Body dissatisfaction (BD) has been consistently linked to adverse consequences on mental health and overall well-being, and is recognized as a significant contributing factor in the initiation and persistence of eating disorders (EDs). Empirical evidence has demonstrated that an elevated body mass index (BMI) and media influence and pressure about a thin ideal heighten the risk of subsequent BD. Moreover, suggestibility, a propensity to accept and act upon messages without critical evaluation, has been shown to be positively associated with greater susceptibility to the influence of sociocultural messages that endorse the thin ideal. This study aimed to assess whether suggestibility moderates the association between BMI and BD in women. Methods: A total of 117 women completed assessments using the Eating Disorder Inventory-3 (EDI-3) BD subscale and the Suggestibility Inventory, which encompasses a general suggestibility index and a subscale that evaluates susceptibility to influence by others. We conducted moderation analyses employing the PROCESS macro, with BMI as the central predictor, BD as the outcome variable, and suggestibility and its subscale as moderators. Results: The findings revealed statistically significant positive moderating interactions for both the general suggestibility index and susceptibility to influence by others. Specifically, women who exhibited high levels of suggestibility and susceptibility to influence by others demonstrated a more pronounced increase in BD as their BMI increased. Conclusions: These outcomes are in line with the sociocultural model of EDs, suggesting that greater susceptibility to external influences amplifies the impact of societal pressures to conform to thin ideals.

Longitudinal Associations among Identity, Internalization of Appearance Ideals, Body Image, and Eating Disorder Symptoms in Community Adolescents and Emerging Adults: Adaptive and Maladaptive Pathways

Previous research examined the role of identity confusion and body dissatisfaction in eating disorder symptoms, but an integrative perspective including identity synthesis and positive body image is lacking. The current study used three-wave longitudinal data (T1: N = 403; 52.1% female; Mage = 14.85, SD = 0.89) spanning two years to examine the directionality of effects among identity, internalization of appearance ideals, body image, and eating disorder symptoms, with attention to adaptive mechanisms. Results revealed a maladaptive pathway in which internalizing appearance ideals posed a risk for body dissatisfaction and eating disorder symptoms. Conversely, an adaptive pathway highlighted the potential protective role of positive body image regarding identity formation and internalization of appearance ideals. This study provides further insight into the critical role of appearance ideal internalization in the development of eating disorders and the potential value of positive body image. Future research and prevention/intervention efforts should focus on promoting resilience to appearance ideal internalization and enhancing positive body image in the context of identity struggles and eating disorder symptoms.

Appearance comparison on social networking sites and body shame: The role of negative body talk and perceived sociocultural influences on body image

Social media platforms play a significant role in the lives of young people. While the usage of these platforms has grown, research exploring the challenges of body image remains limited. This study investigated whether initiating negative body talk functioned as an indirect pathway between appearance comparison on social media and body shame and whether perceived sociocultural influences from parents, friends, and media on body image moderated this indirect effect. An online cross-sectional survey of 795 Chinese college students (Mage = 20.17, SD = 1.65; 60% female, 40% male) was conducted. Negative body talk was a partial indirect pathway in the association, and this indirect effect was significant among those experiencing higher sociocultural pressures from all three sources. This study highlights the need for health psychology in understanding and addressing the mental health consequences associated with digital media and sociocultural influences on body image perception.

An experimental investigation of whether body-positive messaging on fitspiration and diverse images can improve state body image in women

Viewing body-positive content on social media can benefit women's body image. Previous research has conceptualised body positivity broadly, and therefore it remains unclear whether some components are more useful than others. This study examined the impact of body appreciation or body functionality messages (in addition to a mixed condition) overlaid across different image types to influence women's body image. Young women (17-30 years, Mage= 21.53, N = 308) completed an online survey in which they were randomised to view either fitspiration or diverse images overlaid with messaging focusing on body appreciation, body functionality, or a combination. Participants completed pre- and post-test measures of appearance and functionality satisfaction, body appreciation, and body objectification / conceptualisation. Post-test measures of social comparison and perceptions of models were also taken. Results showed that message type did not interact with image type. Rather, exposure to diverse images increased appearance satisfaction and body appreciation, with no changes to functionality satisfaction (vs a decrease for the fitspiration condition). All conditions improved in self-objectification. Further, diverse images resulted in more favourable social comparisons. Our findings consider body positive content in a controlled way and show no differences across body appreciation or body functionality themes.

The whole is more than the sum of its parts: A qualitative investigation of body-dissatisfied college women's experiences of relational body image

Research on relational body image suggests that women's body image changes across their important relationships, with women most at risk for maladaptive body image reporting the most extreme changes. To enrich our understanding of relational body image beyond that offered by prior psychologically-based quantitative research, the present study integrated critical-feminist approaches. Eighteen female-identified university students participated in a one-on-one semi-structured interview. Each participant first completed ratings of her body image across seven important relationships, which the interviewer used to create a graph depicting her relational body image. The interviewer shared the graph with the participant to prompt reflection on her subjective experiences of relational body image and asked her a series of questions. Reflexive thematic analysis, informed by a critical-realist framework, was used to identify themes. One overarching theme, "The Whole Is More than The Sum of Its Parts," demonstrated how relational body image may be understood as a unique configuration of interconnected factors within a specific relationship. Three subthemes then highlighted how interpersonal, idiographic, and systemic factors come together to influence subjective experiences of relational body image. The present results suggest that personalized treatment targets within specific relationships may be a worthwhile focus for future body image interventions.

Do appearance comparisons mediate the effects of thinspiration and fitspiration on body dissatisfaction, happiness, and disordered eating urges in women's daily lives?

We examined whether thinspo and fitspo exposure predicted women's body dissatisfaction (BD), happiness, and disordered eating (DE) urges (binge-eating/purging, restrictive eating, and exercise) in daily life. A further aim was to assess whether these effects were stronger for thinspo versus fitspo exposure and whether upward appearance comparisons mediated the effect of thinspo-fitspo exposure on BD, happiness, and DE urges. Participants (N = 380 women) completed baseline measures and a 7-day ecological momentary assessment (EMA) investigating state-based experiences of thinspo-fitspo exposure, appearance comparisons, BD, happiness, and DE urges. Multilevel analyses revealed that thinspo-fitspo exposure was associated with greater BD and DE urges (but unrelated to happiness) at the same EMA time point. However, there was no association between thinspo-fitspo exposure and BD, happiness, and DE urges at the next EMA time-point. Thinspo relative to fitspo exposure was associated with greater BD (but unrelated to happiness and DE urges) at the same EMA time-point. The proposed mediation models were not supported in time-lagged analyses; such that upward appearance comparisons did not mediate the effects of thinspo-fitspo exposure on BD, happiness, and DE urges. Current findings provide novel micro-longitudinal data on the potentially direct detrimental effects of thinspo-fitspo exposure on women's daily lives.

Appearance Comparisons, Affect, Body Dissatisfaction and Eating Pathology in Portuguese Female University Students

Physical appearance comparisons have been theorized to be associated with negative indicators of body image. This study aimed to study appearance comparisons and their association to affect, body dissatisfaction, and eating pathology. Three hundred and ten female university students with ages between 17 and 25 years (M = 20.2, SD = 1.9) completed sociodemographic and clinical data, self-reported questionnaires, and questions about appearance comparisons. Among the participants, 98.71% reported making appearance comparisons, and 42.15% of these reported making them frequently or always. Higher reported frequencies of appearance comparisons were related to higher levels of body dissatisfaction, negative affect, and eating pathology. Appearance comparisons to acquaintances were the most frequent. Comparisons in person and through media were reported in similar proportions. Upward comparisons were more frequent than lateral and downward comparisons and were related to higher levels of body dissatisfaction than downward comparisons and to higher levels of body dissatisfaction, negative affect, and eating pathology than lateral comparisons. Upward comparisons to close peers were associated with higher body dissatisfaction as opposed to models/celebrities. Results, limitations, and implications are discussed.

The relationship between individual symptom connectivity and global eating disorder symptom severity

BACKGROUND

The network approach has emerged as a useful framework for conceptualizing and investigating psychopathology, including eating disorders. Network connectivity, that is, the density of the connections among network nodes, has been somewhat neglected despite its theoretical relevance. As predicted by network theory, symptom connectivity would be distinct but related to symptom severity and may be a useful clinical indicator of psychopathology as stronger and/or more diffuse connections among symptoms offer more avenues for symptom activation. This study aimed to investigate the relationship between moment-by-moment individual-level symptom connectivity and global levels of symptom severity in the context of eating disorder symptoms and experiences.

METHODS

A sample of 58 female undergraduate college students, mean (SD) age = 20.5 (3.1) provided data on eating disorder symptoms eight times a day over the course of 10 days. Network analyses were used to calculate the eating disorder symptoms network connectivity for each participant. In addition, participants completed survey of self-report measures of eating disorder symptom severity and trait mindfulness and body image flexibility.

RESULTS

Analyses revealed a moderate, positive relationship between individual network connectivity and eating disorder symptom severity. In addition, symptom connectivity predicted unique variance of symptom severity even after controlling for other clinically-relevant variables.

CONCLUSIONS

Individual-level network connectivity may be an important dimension of psychopathology and further work exploring the role of network connectivity is warranted.

PUBLIC SIGNIFICANCE

These findings suggest that symptom severity and the extent to which different eating disorder symptoms are connected are related but different dimensions. Investigating how these different dimensions play a role in eating disorder pathology could help to better understand and treat these disorders.

#SexyBodyPositive: When Sexualization Does Not Undermine Young Women's Body Image

Research suggests that exposure to social networking sites portraying a thin and often sexualized beauty ideal reduces young women's body satisfaction, while exposure to body-positive content improves it. However, it is unclear whether sexualization could impair the beneficial effects of body-positivity messages. Young Italian women were exposed to one of three experimental conditions showing sexualized beauty ideals, sexualized body positivity, or non-sexualized body positivity that appeared either on Instagram (Study 1, N = 356) or TikTok (Study 2, N = 316). Across the two studies, results showed that, regardless of sexualization, exposure to body positivity increased body satisfaction and positive mood compared with pre-exposure measures, while exposure to sexualized beauty ideals reduced it. Participants in the sexualized beauty ideal condition also engaged in upward appearance social comparison whereas body positivity elicited downward comparison. Problematic social networking sites' use moderated the effects of condition on body satisfaction, appearance social comparison, and positive mood, while downward comparison mediated the relation between condition and body satisfaction and positive mood. Our results highlight both beneficial and critical aspects of body positivity that should be taken into consideration when designing body image interventions and policymaking.

Tonight, I'm disordered eating: The effects of food delivery app use, loneliness, and mood on daily body dissatisfaction and disordered eating urges

With the recent proliferation of food delivery applications ('apps'; FDAs), accessing a meal is more convenient and immediate than ever. However, these apps may foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whether FDA use at baseline predicted levels of EMA-assessed disordered eating urges and body dissatisfaction, whether negative mood and loneliness impacted disordered eating urges and body dissatisfaction at the state level, and whether the latter relationships were moderated by FDA usage frequency. Participants (N = 483; 78.7% women; 20.1% men; 1.2% other) completed a baseline questionnaire and were characterised as current FDA users (49.3%) or non-users (50.7%). Participants then completed a smartphone-facilitated investigation into their experiences of loneliness, negative mood, body dissatisfaction, and disordered eating urges, six times per day for 7-days. Across the entire sample, current FDA users at baseline reported greater EMA-assessed urges to overeat. At the state level, loneliness and negative mood predicted greater body dissatisfaction, with the latter also predicting greater urges for restrictive eating and overeating. Among current FDA users at baseline, at the state level, loneliness predicted greater body dissatisfaction, and negative mood predicted greater body dissatisfaction and urges for overeating. No moderating effects were observed for baseline FDA usage frequency. These results elucidate FDA use and daily experiences of loneliness and negative mood as factors elevating eating disorder (ED)-related risk. Further extensions of this research with nuanced measures of state FDA use are required.

The effects of exposure to social media images of thin and average size women on body satisfaction among young women: Emotion regulation and self-efficacy as modulating factors

Although appearance comparison has emerged as an important mechanism underlying the detrimental effects of exposure to idealized social media images on body image among young women, little is known regarding the role of the direction of these comparisons. In addition, to date, little attention has been paid to the role of self-regulation processes in these effects. A sample of 260 female students (M_age = 19.6) from a University in Paris completed an online survey where they were randomly assigned to view thin-ideal or average size social media images of women. Participants reported on state body satisfaction before and after exposure, as well as state appearance comparison and direction of appearance comparison, and trait emotion regulation difficulties and self-efficacy. Findings revealed no main effect of condition. However, among participants who engaged in upwards appearance comparison the thin-ideal condition was associated with greater decreases in body satisfaction. In addition, three-way interactions revealed that emotional regulation difficulties and self-efficacy both further moderated these effects. These findings suggest that self-regulation processes may be important to account for in the effects of exposure to social media images on body satisfaction among young women.

“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.

Feasibility and acceptability of video-based microinterventions for eating disorder prevention among adolescents in secondary schools

OBJECTIVE

Eating disorders (EDs) often emerge in late adolescence. Schools are ideal settings for prevention programs; however, cost and time limit implementation. Microinterventions may overcome these challenges. This study adapted two microinterventions (cognitive dissonance, self-compassion) and assessed feasibility and acceptability among mid-adolescents to provide proof-of-concept for further investigation.

METHOD

Feedback from staff (n = 5) and student (n = 15) focus groups contributed iteratively to the adaptation of intervention materials. Students in Grade 10 and 11 (N = 101, M_age  = 15.80, SD = 0.68) were then randomly allocated by class to a 20-min video-based cognitive-dissonance or self-compassion intervention, accessed on their school devices. ED risk and protective factors were assessed at baseline, immediate postintervention (state outcomes), and 1-week follow-up (trait outcomes). Acceptability items were included at both timepoints.

RESULTS

Implementation was deemed feasible. Girls generally reported greater acceptability than boys. Among girls, the self-compassion intervention demonstrated greater acceptability. Among boys, some aspects of acceptability (e.g., lesson endorsement, utilization of techniques) were rated higher in the cognitive dissonance group whereas other aspects (e.g., understanding, interest) were greater in the self-compassion group. All groups exhibited favorable changes in most state outcomes, however trait outcome change was varied.

DISCUSSION

Microinterventions provide a feasible way of implementing prevention strategies in a time-poor educational context. Future large-scale evaluation is warranted to determine efficacy, following modifications based on current findings.

PUBLIC SIGNIFICANCE

This study shows promising feasibility and acceptability of two brief, self-guided video-based lessons (microinterventions) for adolescents in school classrooms, that use psychological techniques to target appearance pressures as a key risk factor for eating disorders. Such interventions are easier to implement in school settings than longer, facilitator-led interventions, to encourage greater uptake and ongoing use. Findings support further research to evaluate effectiveness, to ultimately provide accessible and gender-inclusive tools for busy schools.

The Effects of Appearance-Based Comments and Non-Appearance-Based Evaluations on Body Dissatisfaction and Disordered Eating Urges: An Ecological Momentary Assessment Study

The current study used ecological momentary assessment (EMA) to investigate whether appearance-based comments, social and performance-based evaluations affected levels of body dissatisfaction (BD) and urges to engage in disordered eating behaviors (DE) throughout daily life. A total of 620 participants completed a baseline questionnaire assessing sociodemographic variables. Participants then downloaded a mobile app which alerted them to complete short surveys assessing their levels of BD, DE urges, and experiences of receiving comments and evaluations six times per day for 7 days. Negative appearance-based comments predicted greater levels of state BD, while positive appearance comments predicted lower levels of state BD. Negative social and performance-based evaluations predicted an increase in state BD, while positive evaluations predicted a decrease in this outcome variable. No significant predictor was found for the DE urge outcomes. The present findings suggest that receiving negative and positive feedback in various domains of one's life may predict opposite outcomes for body image. However, these effects do not necessarily associate with urges to engage in DE in a nonclinical population.

Is Childhood Maltreatment Associated with Body Image Disturbances in Adulthood? A Systematic Review and Meta-Analysis

PURPOSE

We aimed to synthesize the evidence for an association between childhood maltreatment and body image disturbances in adulthood. Information on maltreatment subtypes and mediator variables was included to gain further insights into the mechanisms of the association. In addition, we aimed to examine the role of body image disturbances in the development of negative mental health outcomes associated with childhood maltreatment.

METHODS

Based on a comprehensive search strategy, eligible studies were identified in PubMed, Scopus, and Web of Science. The eligibility assessment was performed by two reviewers, and 132 articles were studied full-text. To reduce heterogeneity, only non-clinical samples were included in the meta-analysis. A meta-regression was computed to examine the influence of maltreatment subtype on body image disturbances.

RESULTS

Our results provide evidence for a robust association between childhood maltreatment and cognitive-affective body image, both in clinical and community samples. Included studies (N = 40) indicate that body image disturbances are especially pronounced in individuals suffering from Posttraumatic Stress Disorder (PTSD) after childhood maltreatment. The meta-analysis included 12 studies with a total of 15.481 participants, and indicates a small overall effect size (r = 0.21, 95% CI = [0.16, 0.26], p < .001). Meta-regression revealed no significant impact of maltreatment subtype in non-clinical samples.

CONCLUSION

Childhood maltreatment should be considered as a distal risk factor for the development of a negative cognitive-affective body image. We argue for future longitudinal studies which allow a better understanding of the pathways linking childhood maltreatment, body image disturbances and associated psychopathology.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-021-00379-5.

The impact of nature exposure on body image and happiness: an experience sampling study

Exposure to nature is associated with improved psychological well-being and positive body image. Here, we examined whether everyday exposure to natural environments is associated with state body image outcomes (and, for comparative reasons, state happiness) using an experience sampling method. One-hundred-and-seven participants completed a 30-day experience sampling phase in which they reported their state body image (body weight, body shape, and physical appearance satisfaction), state happiness, and features of the surrounding environment (total = 6,025 responses) at three random time-points each day. Results indicated that being outdoors was associated with significantly higher state body image on all three indicators, but effect sizes were lower compared to effects on state happiness. Specific environment type was also important, with blue-spaces and wood- and grasslands, respectively, having stronger effects than other environments. These results provide evidence that everyday exposure to natural environments is associated with more positive state body image and greater happiness.

Fear of fatness and desire for thinness as distinct experiences: A qualitative exploration

OBJECTIVE

The pursuit of thinness and fear of gaining weight have been found to play an important role in eating disorder symptomatology. While these dimensions have typically been considered conjointly, emerging evidence suggests they may be distinct dimensions. The aim of this study was to explore the subjective experiences of fear of fatness and drive for thinness in young women with body image concerns.

METHOD

Young women endorsing weight concerns (N = 29, mean age = 20.86, SD = 2.70 years) were interviewed and asked to describe an experience of fear of fat and drive for thinness, respectively.

RESULTS

Qualitative analysis was conducted and identified four themes: (1) precipitating events; (2) physiological, emotional, cognitive, and proprioceptive experiences; (3) coping strategies; and (4) sociocultural influences. While similarities emerged, the experiences of fear of fatness, and of drive for thinness also evidenced clear differences situating the former in the context of fear-based avoidance patterns, and the latter in approach-based reward models.

DISCUSSION

These findings provide additional support for the usefulness of considering fear of fat and drive for thinness as distinct constructs. Further research examining the contributions of each of these constructs to eating pathology is warranted.

Body image and acceptance of cosmetic surgery in China and the Netherlands: A qualitative study on cultural differences and similarities

There is an established relationship between acceptance of cosmetic surgery and psychological factors, including body image. However, qualitative research among diverse cultural groups is needed to provide a more fine-grained understanding of the influences on women's attitudes towards cosmetic surgery. In this study, 20 Chinese and 20 Dutch women aged 18-50 years (M_Chinese = 34.20; M_Dutch = 34.70) participated in one-on-one semi-structured interviews. Data were analyzed using reflexive thematic analysis. We identified three themes that captured the factors that women perceived to foster favorable attitudes towards cosmetic surgery: (a) sociocultural pressures (e.g., normalization of cosmetic surgery, appearance-focused peers); (b) intrapersonal characteristics (e.g., beauty-ideal internalization, social comparison); and (c) benefits of beauty (e.g., attracting men, socioeconomic benefits). Conversely, two themes captured the factors perceived to reduce favorable attitudes towards cosmetic surgery: (a) intrapersonal characteristics (e.g., unconditional body acceptance, self-confidence); and (b) external considerations (e.g., health risks, financial costs). Overall, Chinese and Dutch participants shared many similarities in their opinions about what might affect cosmetic surgery consideration. The most striking cross-cultural differences concerned perceived socioeconomic benefits of beauty (mainly Chinese women) and women's conceptualization of body appreciation. This study may enable a more comprehensive understanding about the factors influencing Chinese and Dutch women's attitudes towards cosmetic surgery, and the nuances in these relationships across these cultures.

Love me Tinder: The effects of women's lifetime dating app use on daily body dissatisfaction, disordered eating urges, and negative mood

Dating apps may potentially serve as an environment that subjects young women to the harmful effects of appearance-related pressure. The current study assessed for the first time whether women's dating app use predicted body dissatisfaction (BD), urges to engage in disordered eating (DE), and negative mood in daily life. We also examined the unique effects of women's dating app partner preferences (i.e., seeking idealised versus non-idealised physical characteristics) on the aforementioned outcomes, and whether appearance-based rejection sensitivity (appearance-RS) moderated the effects of dating app use. Participants (N = 296; 100% women) first completed a baseline survey assessing lifetime dating app usage (i.e., current or former usage), partner preferences, and appearance-RS, followed by a 7-day smartphone-facilitated ecological investigation into momentary experiences of BD, DE urges (i.e., binge-eating/purging, dietary restraint, and exercise), and negative mood. Ninety-four women (32%) reported lifetime dating app usage, which, relative to non-use, predicted greater daily urges for binge-eating/purging and negative mood. However, appearance-RS failed to moderate these effects. Among dating app users, partner preferences were not a significant predictor of the central outcomes. These findings extend previous research by examining the unique effects of dating app use on everyday BD, DE urges, and negative mood. Replication and extension are encouraged.

"Ur a freakin goddess!": Examining Appearance Commentary on Instagram

Frequent use of highly visual online platforms such as Instagram may be linked to greater body image concerns. One prominent feature of Instagram is the ability to receive feedback in the form of likes and comments. The goal of this cross-sectional study (conducted in laboratory and online) was to examine college students' receipt of appearance commentary on their most recent Instagram posts, and how this relates to their self-reported body image concerns. The Instagram commentary that 337 students (M _age=20.39) received on their posts was observationally coded for positivity and negativity. Receiving positive appearance commentary was common and linked to greater appearance-related social media consciousness, and, weakly, to body surveillance. There were no associations with self-objectification, appearance-contingent self-worth, facial satisfaction, and body dissatisfaction. Negative appearance commentary was not associated with body image concerns. Photos depicting only the self were especially likely to elicit positive appearance commentary. Females received more positive appearance commentary compared to males, whereas males received more negative appearance commentary. Future research should examine long-term effects of receiving appearance comments via Instagram.

Targets of comparison and body image in women's everyday lives: The role of perceived attainability

Appearance comparisons can negatively influence women's body image, but little is known about the potential impact of comparison targets. We conducted an ecological momentary assessment study in which female undergraduate students (N = 146) completed a brief online survey at five random times every day for five days. In this survey, participants were asked if they had made an appearance comparison. If so, they were asked who they compared themselves to (i.e., close peer, acquaintance, stranger, celebrity/model), how they rated compared to that person (i.e., more attractive, just as attractive, less attractive), and how attainable that person's appearance is to them. All participants then completed state measures of mood, appearance satisfaction, and intention to diet and exercise. Upward comparisons (i.e., to more attractive others) to all targets were associated with less appearance satisfaction, lower positive mood, and more thoughts of dieting and exercising than when no comparisons were made. There were indirect relationships between comparisons to celebrities/models versus all other targets and appearance satisfaction via perceived attainability of the target's appearance. These findings suggest that celebrities may be particularly harmful appearance comparison targets in women's everyday lives because their attractive appearance is perceived to be less personally attainable than other targets.

Assessing positive body image, body satisfaction, weight bias, and appearance comparison in emerging adults: A cross-validation study across eight countries

Positive body image refers to individuals' ability to conceptualize their bodies with love, respect, and appreciation. The study of positive body image is relatively new, and instruments used to investigate this multi-faceted construct have received limited use in non-English speaking countries. Thus, the aim of this investigation is to consider four measures that are associated with positive body image across eight different countries. Participants (n = 6272) completed the Body Appreciation Scale-2, the Body Areas Satisfaction Scale, the Physical Appearance Comparison Scale, and the Weight Bias Internalization Scale. Multi-group confirmatory factor analyses (MG-CFAs) and item-response theory (IRT) models were used to examine the measurement invariance of these surveys. Our results generally suggest that positive body image, weight bias, and appearance comparison can be assessed using brief assessments and that these four instruments can be used in different countries, but care should be taken to consider individuals' gender, BMI, and socio-economic position.

Rationale and Design of the Women's Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women's Physical Activity

BACKGROUND

Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment.

OBJECTIVE

The overarching goal of Project WHADE (Women's Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women's psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual).

METHODS

Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims.

RESULTS

Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020.

CONCLUSIONS

Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women's PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19044.

Validation of a Spanish Version of the Physical Appearance Comparison Scales

Physical appearance comparison has been widely studied because of its strong relationship with body dissatisfaction and disordered eating. The main objective of this study was to validate the physical appearance comparison scales (PACS-Revised and PACS-3) in a sample of Spanish men and women and examine their psychometric properties. The sample consisted of 1151 participants (age M = 22.31, SD = 3.40). A unidimensional structure was corroborated in the PACS-R, and three factors in the PACS-3 (proximal, distal, and muscularity comparisons). The PACS-R and PACS-3 showed full scalar invariance across sex. The internal consistency for the PACS-R and subscales of PACS-3 were satisfactory. Positive statistically significant relationships were found with measures of disordered eating (EAT-26) and dysmorphic concern (DCQ). Hierarchical multiple regression analyses demonstrated that the PACS-3 discretely improved the prediction of disordered eating over PACS-R, but did not show improvement in the prediction of dysmorphic concern beyond the PACS-R. These findings suggest that the PACS-R and PACS-3 may be useful tools for evaluating the tendency of men and women to compare their physical appearance.

The development of a body comparison measure: the CoSS

PURPOSE

This study reports on the development and validation of a brief and widely applicable measure of body comparison (the Comparison of Self-Scale-CoSS), which is a maintaining feature of eating disorders.

METHODS

A sample of 412 adults completed the CoSS, an existing measure of aspects of body comparison, and eating pathology and associated states. Test-retest reliability was examined over 2 weeks.

RESULTS

Exploratory factor analysis showed that 22 CoSS items loaded onto two factors, resulting in two scales-Appearance Comparison and Social Comparison-with strong internal consistency and test-retest reliability.

CONCLUSIONS

In clinical terms, the CoSS was superior to the existing measure of body comparison in accounting for depression and anxiety. Given that it is a relatively brief measure, the CoSS could be useful in the routine assessment of body comparison, and in formulating and treating individuals with body image concerns. However, the measure awaits full clinical validation.

LEVEL OF EVIDENCE

Level 3.

State-Based Markers of Disordered Eating Symptom Severity

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic significance of these state-based dynamics for predicting trait-level eating disorder severity, however, remains largely unexplored. The present study uses within-person relationships among state levels of negative mood, body image, and dieting as predictors of baseline, trait-level eating pathology, captured prior to a period of state-based data capture. Two-hundred and sixty women from the general population completed baseline measures of trait eating pathology and demographics, followed by a 7 to 10-day ecological momentary assessment phase comprising items measuring state body dissatisfaction, negative mood, upward appearance comparisons, and dietary restraint administered 6 times daily. Regression-based analyses showed that, in combination, state-based dynamics accounted for 34-43% variance explained in trait eating pathology, contingent on eating disorder symptom severity. Present findings highlight the viability of within-person, state-based dynamics as predictors of baseline trait-level disordered eating severity. Longitudinal testing is needed to determine whether these dynamics account for changes in disordered eating over time.

An Ecological Momentary Assessment of Self-improvement and Self-evaluation Body Comparisons: Associations with College Women's Body Dissatisfaction and Exercise

Upward body comparisons are prevalent among college women and associated with body dissatisfaction and disordered eating. However, less is known about distinguishing features of the comparisons themselves as they occur in daily life. The primary purpose of the present study was to examine whether two types of upward body comparisons previously studied experimentally (self-improvement and self-evaluation) are differentially associated with body- and exercise-related outcomes in real-life settings using ecological momentary assessment (EMA). Undergraduate women (N = 74) between 18-25 years (Mage = 20.4, SD = 1.63) completed five surveys on smartphones daily for seven days. EMA measures assessed body comparisons, body dissatisfaction, and exercise cognitions and behaviors. Baseline body dissatisfaction, comparison tendency, and exercise behavior were examined as moderators. Multilevel analyses revealed that both self-improvement and self-evaluation were associated with greater exercise thoughts (ps < .05), but not with changes in body dissatisfaction (ps> .05). Moderator analyses revealed differences between the two types and their associations with outcomes for select subgroups. For example, self-improvement comparisons were associated with fewer exercise thoughts among participants with high baseline exercise behaviors (p < .01). Further research is needed to understand the differences between self-improvement and self-evaluation and the potential protective mechanisms of self-improvement.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

Experimental study, Level 1.

The Happy American Body 2.0: Predictors of affective body satisfaction in two U.S. national internet panel surveys

The first national study of body image was reported four decades ago in the article The Happy American Body (Berscheid et al., 1973). To provide a modern follow-up to this study, we used two Internet panel surveys of U.S. adults to examine feelings about appearance (Survey 1: Married N = 1095; Single N = 5481) and weight, appearance, body, and muscle size/tone (Survey 2: N = 1601). Mean ages across samples for men and women ranged from 42-53. On the positive side, many men and women were somewhat-to-very satisfied with their appearance (67 %; 57 %), overall body (61 %; 46 %), weight (54 %; 42 %), and muscle tone/size (56 %; 41 %). Mean gender differences were small (Cohen's ds = 0.18-0.32), as were sexual orientation differences within each gender (ds = |0.00-0.25|). Looking at negative body image, fewer men than women were somewhat-to-very unhappy with their appearance among married (19 %; 29 %) and single participants (29 %; 35 %), and fewer men were somewhat-to-extremely dissatisfied with their appearance (18 %; 24 %), body (27 %; 39 %), weight (36 %; 49 %), muscle tone/size (27 %; 41 %). Nearly one-fifth of men (18 %) and one-fourth of women (27 %) were very-to-extremely dissatisfied with at least one of these traits, highlighting the importance of body image interventions.

Methods to Assess Social Comparison Processes Within Persons in Daily Life: A Scoping Review

Self-evaluations relative to others (i.e., social comparisons) have well-established implications for health and well-being, and are typically assessed via global, retrospective self-report. Yet, comparison is inherently a dynamic, within-person process; comparisons occur at different times, on a range of dimensions, with consequences that can vary by context. Global, retrospective assessment forces aggregation across contexts and reduces ecological validity, limiting its utility for informing a nuanced understanding of comparisons in daily life. Research across social and clinical psychology has implemented methods to assess comparisons naturalistically, involving intensive, repeated assessments of comparison occurrence, characteristics, and consequences in everyday life (via ecological momentary assessment or daily diaries). Although promising, this work to date lacks an overarching conceptual framework for guiding decisions about assessment design and implementation. To address this gap, the aims of this scoping review were: (1) to summarize available literature on within-person naturalistic assessment of social comparison, and (2) to provide a set of key considerations to inform future social comparison research using within-person naturalistic assessment. Searches in PubMed, PsycInfo, and CINAHL identified relevant articles published before June 2019. Articles were included if they described at least 3 comparison assessments within each participant, taken in the natural environment, and spaced no more than ~24 h apart (i.e., repeated momentary or daily assessment). In articles meeting these criteria (33 unique studies across 36 published papers), we summarized aspects of the comparison assessment, including recording methods, direction (e.g., upward, downward), target (e.g., friend, stranger), and dimension (e.g., status, appearance). Most studies assessed appearance comparisons (vs. other comparison dimensions) and collected information in response to signals (rather than initiated by participants). However, there was considerable heterogeneity in the number of assessments, assessment periods, recording modalities, and comparison predictors and outcomes assessed. Findings broadly establish heterogeneity in the aspects of comparison considered critical for within-person naturalistic assessment. We describe key decision points for future work to help advance within-person naturalistic assessment methods and improve the utility of such approaches to inform research, theory, and intervention.

Body image states in everyday life: Evidence from ecological momentary assessment methodology

This review highlights the contributions of Professor Thomas Cash to the scholarship of body image experiences in daily life, including his influence on subsequent research in this field. Cash's arguments for capturing a broad range of state-based body image experiences have been heeded, with recent studies exploring positive body image constructs as well as the more studied negative body image experiences. Appearance comparisons are the most commonly studied contextual influence on body image, and they seem to have a consistent effect. However, the experiences of body image in sexual contexts, and among adolescents, those who are pregnant, or have other physical characteristics that may increase the salience of appearance warrant further attention. Findings generally support Cash's contention that trait body image relates to likelihood and level of experience of body image in daily life, though the moderating effects of trait aspects on state-based relationships remains unclear. The discussion concludes with consideration of the impact of assessment schedules on obtained results. It is also discussed how accumulated knowledge regarding state-based body image experiences may be leveraged in treatment contexts, particularly in light of clear evidence that repeated assessment of body image in daily life increases self-awareness of one's body image characteristics.

Trait body image flexibility as a predictor of body image states in everyday life of young Australian women

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons, drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.

Effect of digital alteration information and disclaimer labels attached to fashion magazine advertisements on women's body dissatisfaction

The present study aimed to investigate whether the provision of prior information about digital alteration would enhance the effectiveness of disclaimer labels attached to fashion images in protecting against body dissatisfaction. Participants were 363 female undergraduate students who viewed fashion magazine advertisements with either no label or a digital alteration disclaimer label. Prior to viewing the advertisements, participants read one of three news stories containing digital alteration information that focused on either the unrealistic nature of the images or on social comparison, or a control news story (on magazine circulation figures). Irrespective of the preceding information, disclaimer labels offered no benefit for body satisfaction. However, reading the news articles containing information about digital alteration led to higher levels of body dissatisfaction than reading the control article. It was concluded that information in the form of news stories or disclaimer labels cannot be assumed to be useful or to offer positive benefit. Accordingly, more extensive and thorough evaluation is required and policy makers might better direct their attention to other forms of cost-effective universal intervention.