Implicit internalization of the thin ideal as a predictor of increases in weight, body dissatisfaction, and disordered eating

Measuring implicit associations between food and body stimuli in anorexia nervosa: a Go/No-Go Association Task

PURPOSE

The present study aimed to explore the implicit associations between food and bodily stimuli in patients with anorexia nervosa (AN) and control subjects (HC).

METHODS

A Go/No-Go Association Task was administrated to 55 participants (28 AN and 27 HC), using food stimuli (low-calorie food vs. high-calorie food) and body stimuli (underweight vs. overweight bodies).

RESULTS

We evidenced an implicit association between food and body stimuli in the AN group, whereas the HC group only showed a tendency. AN and HC groups also exhibited different categorization strategies: the AN group tended to categorize stimuli as low-calorie foods and underweight bodies less than the HC group, and they tended to categorize stimuli as high-calorie foods and overweight bodies more than the HC group.

CONCLUSION

The present study revealed for the first time specificities of the AN population's implicit association between food and body stimuli in terms of association strength and categorization strategy. Furthermore, the results suggest that combining implicit methodologies with other methods could contribute to a better characterization of the physiopathology of AN.

LEVEL OF EVIDENCE

Level I, experimental study.

Assessment of medical student burnout: toward an implicit measure to address current issues

The feasibility of implicitly assessing medical student burnout was explored, using the Implicit Relational Assessment Procedure (IRAP), to measure longitudinal student burnout over the first two years of medical school and directly comparing it with an existing explicit measure of burnout (Maslach Burnout Inventory; MBI). Three successive cohorts of medical students completed both implicit and explicit measures of burnout at several time points during their first two years of medical school. Both assessments were conducted via the internet within a one-week period during the first week of medical school, the end of the first year of medical school, and the end of the second year, though not all cohorts were able to complete the assessments at all time points. Mixed linear models were used to compare the two measures directly, as well as to evaluate changes over time in each measure separately. Minimal correspondence was observed between the implicit and explicit measures of burnout on a within-subject basis. However, when analyzed separately, all subscales of both measures detected significant change over time in the direction of greater levels of burnout, particularly during the first year of medical school. These results provide preliminary evidence the IRAP is able to assess implicit attitudes related to burnout among medical students, though additional research is needed. The IRAP detected consistent improvements in positive implicit attitudes toward medical training during students' second year of medical school, which was not detected by the MBI. Possible implications of these findings are discussed.

Systemic and Environmental Contributors to Obesity Inequities in Marginalized Racial and Ethnic Groups

Obesity is a multifactorial disease that disproportionally affects diverse racial and ethnic groups. Structural racism influences racial inequities in obesity prevalence through environmental factors, such as racism and discrimination, socioeconomic status, increased levels of stress, and bias in the health care delivery system. Researchers, clinicians, and policy makers must work to address the environmental and systematic barriers that contribute to health inequities in the United States. Specifically, clinicians should quantitatively and qualitatively assess environmental and social factors and proactively engage in patient-centered care to tailor available treatments based on identified needs and experiences.

Implicit bias to food and body cues in eating disorders: a systematic review

BACKGROUND

Rigid, restrictive eating patterns, fear of gaining weight, body image concerns, but also binge eating episodes with loss of control leading to overweight, at times followed by compensatory measures to control weight, are typical symptoms in eating disorders (EDs). The regulation of food intake in EDs may underlie explicit processes that require cognitive insight and conscious control or be steered by implicit mechanisms that are mostly automatic, rapid, and associated with affective-rather than cognitive-processing. While introspection is not capable of assessing implicit responses, so-called indirect experimental tasks can assess implicit responses underlying a specific behavior by-passing the participant's consciousness. Here, we aimed to present the current evidence regarding studies on implicit biases to food and body cues in patients with EDs.

METHODS

We performed a systematic review (PRISMA guidelines). We included controlled studies performed in clinical ED cohorts (vs. healthy control subjects or another control condition, e.g., restrictive vs. binge/purge AN) and using at least one indirect assessment method of interest.

RESULTS

Out of 115 screened publications, we identified 29 studies fulfilling the eligibility criteria, and present a synthesis of the essential findings and future directions.

CONCLUSION

In this emerging field of research, the present work provides cornerstones of evidence highlighting aspects of implicit regulation in eating disorders. Applying both direct (e.g., self-reports) and indirect measures for the assessment of both explicit and implicit responses is necessary for a comprehensive investigation of the interplay between these different regulatory mechanisms and eating behavior. Targeted training of implicit reactions is already in use and represents a useful future tool as an add-on to standard psychotherapeutic treatments in the battle against eating disorders.

EVIDENCE LEVEL

1 (systematic review).

Relations between implicit attitudes towards eating disorder stimuli and disordered eating symptoms among at-risk college women

This study examined implicit attitudes towards different eating disorder (ED) relevant stimuli- emaciation, hard-exercise, the self, and eating related stimuli-and their relationship with explicit ED symptoms in two symptomatic samples of college-aged women. Study 1 found that positive implicit attitudes towards eating and self-relevant images were associated with greater state body image satisfaction and self-esteem and with less ED-related intentions. Study 2 found that positive implicit attitudes towards eating and self-relevant images were associated with less trait global ED psychopathology and distress and greater self-esteem. Overall, positive implicit evaluations of eating and self-related stimuli were negatively associated with ED symptoms and related psychopathology and positively related to self-esteem. However, implicit attitudes towards emaciation and hard exercise were not associated with explicit ED symptoms in either sample. These findings suggest that implicit attitudes towards eating and self-related stimuli, in particular, may be viable targets for reconditioning in novel treatment paradigms such as therapeutic evaluative conditioning interventions.

Disordered eating in the postpartum period: Role of psychological distress, body dissatisfaction, dysfunctional maternal beliefs and self-compassion

The present cross-sectional study tested the affect regulation model of disordered eating for women in the postpartum period, whereby disordered eating is used to cope with psychological distress. Two hundred and two women who had given birth in the last two years completed an online survey of self-report measures of study variables. Path analyses supported the primary hypothesis: negative affect mediated relationships between body dissatisfaction, dysfunctional maternal beliefs, negative components of self-compassion and disordered eating behaviours, particularly binge eating. Results suggest that negative affect plays a central role in postpartum disordered eating. Interventions to address maladaptive emotion regulation strategies, specifically targeting body image distress and self-critical maternal thoughts may improve eating behaviours for this population.

A Systematic Review Of Implicit Attitudes And Their Neural Correlates In Eating Behaviour

An increasing number of studies suggests that implicit attitudes toward food and body shape predict eating behaviour and characterize patients with eating disorders (EDs). However, literature has not been previously analysed, thus differences between patients with EDs and healthy controls and the level of automaticity of the processes involved in implicit attitudes are still matters of debate. The present systematic review aimed to synthetize current evidence from papers investigating implicit attitudes towards food and body in healthy and EDs populations. PubMed, EMBASE (Ovid), PsycINFO, Web of Science and Scopus were systematically screened and 183 studies using different indirect paradigms were included in the qualitative analysis. The majority of studies reported negative attitudes towards overweight/obese body images in healthy and EDs samples and weight bias as a diffuse stereotypical evaluation. Implicit food attitudes are consistently reported as valid predictors of eating behaviour. Few studies on the neurobiological correlates showed neurostimulation effects on implicit attitudes, but the automaticity at brain level of implicit evaluations remains an open area of research. In conclusion, implicit attitudes are relevant measures of eating behaviour in healthy and clinical settings, although evidence about their neural correlates is limited.

Preliminary development of an implicit association test to measure body dissatisfaction and predict disordered eating behaviors

We conducted a preliminary test of a novel implicit association test for body dissatisfaction (BD-IAT). We predicted that BD-IAT would correlate with self-reported BD and predict later eating disorder (ED) attitudes. Female undergraduates (N = 145) self-reported BD and ED attitudes. In the BD-IAT, participants sorted words related to "satisfaction" and "dissatisfaction" to opposite sides of a computer screen. Participants categorized pictures of themselves to the side of the screen with the word "Me," which appeared with the "satisfied" or "dissatisfied" category in separate blocks. The BD-IAT measured the strength of the association between a participant's own body and dissatisfaction. The BD-IAT correlated positively with the EDI-BD (r = 0.21, p < 0.05), supporting its convergent validity. The BD-IAT predicted ED attitudes at one-week follow-up, controlling for explicit BD and baseline ED (b = 0.58, SE = 0.23, t = 2.57, p = .01); IAT scores uniquely accounted for 4.7 % of the variance in ED at one-week follow-up. These results provide preliminary evidence for the BD-IAT as an implicit measure of BD and suggest that it may predict future ED attitudes above and beyond explicit BD. Directions for future work aimed at continued development of this task are discussed.

A personalized approach-avoidance modification intervention to reduce negative body image. A placebo-controlled pilot study

BACKGROUND AND OBJECTIVES

Drive for thinness is considered an important factor in the onset and maintenance of negative body image and can be conceptualized as a motivational approach tendency towards thin bodies. The goal of this study was to test whether training thinness-related approach-avoidance tendencies is effective in improving body satisfaction using a personalized training with individuals' own body pictures.

METHODS

Undergraduate women scoring high on drive for thinness (N = 104) were randomly assigned to an experimental, placebo or no training control condition. The experimental training consisted of four training sessions in which participants pushed away thin versions of their own body pictures and pulled closer realistic pictures of themselves. The same stimuli were shown with 50/50 contingency in the placebo training.

RESULTS

The experimental training procedure did not show an effect on self-reported body satisfaction or drive for thinness after one session, four sessions, or one week later. While reaction time indices suggested a marginally significant change in approach-avoidance tendencies in the expected direction, this effect may have been driven by relatively strong thin-approach tendencies in the experimental condition before the start of the training.

LIMITATIONS

High error rates limit the interpretability of the effects on approach-avoidance tendencies. Selection was based on a single item assessing drive for thinness.

CONCLUSIONS

Taken together, our study did not provide evidence that training approach-avoidance tendencies is effective in improving negative body image.

Polygenic Score for Body Mass Index Is Associated with Disordered Eating in a General Population Cohort

BACKGROUND

Disordered eating (DE) is common and is associated with body mass index (BMI). We investigated whether genetic variants for BMI were associated with DE. Methods: BMI polygenic scores (PGS) were calculated for participants of the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 8654) and their association with DE tested. Data on DE behaviors (e.g., binge eating and compensatory behaviors) were collected at ages 14, 16, 18 years, and DE cognitions (e.g., body dissatisfaction) at 14 years. Mediation analyses determined whether BMI mediated the association between the BMI-PGS and DE. Results: The BMI-PGS was positively associated with fasting (OR = 1.42, 95% CI = 1.25, 1.61), binge eating (OR = 1.28, 95% CI = 1.12, 1.46), purging (OR = 1.20, 95% CI = 1.02, 1.42), body dissatisfaction (Beta = 0.99, 95% CI = 0.77, 1.22), restrained eating (Beta = 0.14, 95% CI = 0.10, 1.17), emotional eating (Beta = 0.21, 95% CI = 0.052, 0.38), and negatively associated with thin ideal internalization (Beta = -0.15, 95% CI = -0.23, -0.07) and external eating (Beta = -0.19, 95% CI = -0.30, -0.09). These associations were mainly mediated by BMI. Conclusions: Genetic variants associated with BMI are also associated with DE. This association was mediated through BMI suggesting that weight potentially sits on the pathway from genetic liability to DE.

Stereotypes of physical attractiveness and social influences: The heritage and vision of Dr. Thomas Cash

Dr. Thomas Cash conducted seminal work on the beliefs and stereotypes related to attractiveness as well as their impact, and their transmission through cultural and interpersonal processes. This initial work has inspired and given rise to an important body of research significantly increasing our understanding of these processes. Here we review the initial contributions and research directions set up by Dr. Cash, as well as the main findings of the research that has built on his foundations. Specifically, we review findings related to the existence of attractiveness stereotypes and appearance ideals, research examining the social and interpersonal impacts of such stereotypes, and finally the sociocultural transmission of these beliefs. Future directions related to the extension of our understanding to appearance characteristics beyond shape and weight, as well as increased focus on minority identities and their intersection, are proposed.

Implicit Attitudes to Female Body Shape in Spanish Women With High and Low Body Dissatisfaction

Research on implicit attitudes to body image has grown substantially in recent years. The extant evidence reveals an implicit weight bias in the general population that has generally been interpreted in terms of anti-fat attitudes. However, research with the Implicit Relational Assessment Procedure (IRAP) shows that this bias appears to be driven by pro-slim rather than anti-fat implicit attitudes. Besides, the only IRAP study of this sort conducted in Spain found no evidence of such implicit weight bias (with similarly positive attitudes to thinness and fatness). Given the existing differences in body dissatisfaction (BD) among diverse cultural contexts, we predicted that discrepancies in findings about implicit weight bias might be related to differences in BD amongst the samples in the different studies. This study explores whether women with extreme scores in BD (High vs. Low) show different patterns of attitudes to female body shape. Spanish female college students with extreme scores in the Body Shape Questionnaire (BSQ: high ≥ 104, percentile 80; low ≤ 52, percentile 20) completed an IRAP with pictures of overweight and underweight women as target stimuli and the words pleasant and unpleasant as labels. Participants also completed explicit ratings to the same stimuli and clinically relevant measures of body image related distress. Results showed an implicit weight bias only for women high in BD. While both groups showed equally positive implicit attitudes to thinness, only women with low BD showed implicit positive attitudes to fatness (and hence no bias). In turn, both groups presented a clear pro-thin/anti-fat explicit bias with positive ratings for underweight pictures and negative ratings for overweight pictures. The latter were stronger for the high BD group. Therefore, between-group differences were mainly driven by differences in attitudes to fatness (both implicit and explicit). Both implicit and explicit attitudes to fatness independently predicted eating disorders symptoms and other clinically relevant measures. These results are discussed in terms of their clinical implications.

Implicit attitudes toward dieting and thinness distinguish fat-phobic and non-fat-phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents

OBJECTIVE

The majority of individuals with anorexia nervosa (AN) have a fat-phobic (FP-AN) presentation in which they explicitly endorse fear of weight gain, but a minority present as non-fat-phobic (NFP-AN). Diagnostic criteria for avoidant/restrictive food intake disorder (ARFID) specifically exclude fear of weight gain. Differential diagnosis between NFP-AN and ARFID can be challenging and explicit endorsements do not necessarily match internal beliefs.

METHOD

Ninety-four adolescent females (39 FP-AN, 13 NFP-AN, 10 low-weight ARFID, 32 healthy controls [HC]) completed implicit association tests (IATs) categorizing statements as pro-dieting or non-dieting and true or false (questionnaire-based IAT), and images of female models as underweight or normal-weight and words as positive or negative (picture-based IAT). We used the Eating Disorder Examination to categorize FP- versus NFP-AN presentations.

RESULTS

Individuals with FP-AN and NFP-AN demonstrated a stronger association between pro-dieting and true statements, whereas those with ARFID and HCs demonstrated a stronger association between pro-dieting and false statements. Furthermore, while all groups demonstrated a negative implicit association with underweight models, HC participants had a significantly stronger negative association than individuals with FP-AN and NFP-AN.

DISCUSSION

Individuals with NFP-AN exhibited a mixed pattern in which some of their implicit associations were consistent with their explicit endorsements, whereas others were not, possibly reflecting a minimizing response style on explicit measures. In contrast, individuals with ARFID demonstrated implicit associations consistent with explicit endorsements. Replication studies are needed to confirm whether the questionnaire-based IAT is a promising method of differentiating between restrictive eating disorders that share similar clinical characteristics.

Nature and consequences of positively-intended fat talk in daily life

The current study used ecological momentary assessment to explore the frequency, trait predictors, and momentary consequences of positively-intended fat talk, a specific sub-type of fat talk that involves making negative comments about one's own appearance with the view to making someone else feel better. A total of 135 women aged 18-40 completed trait measures of appearance-based comparisons, thin-ideal internalisation, body shame, and body surveillance, before completing a state-based component, involving six short surveys delivered via a smartphone app at random points during the day for seven days. Findings indicate that both self- and other-fat talk are common in daily social interactions, and that individuals with higher levels of trait negative body image were more likely to engage in fat talk. Self-fat talk negatively impacted state body satisfaction levels. Possible theoretical and practical implications are outlined.

Implicit Measures of Actual Versus Ideal Body Image: Relations with Self-Reported Body Dissatisfaction and Dieting Behaviors

Body dissatisfaction refers to a negative appreciation of one's own body stemming from a discrepancy between how one perceives his/her body (actual body image) and how he/she wants it to be (ideal body image). To circumvent the limitations of self-report measures of body image, measures were developed that allow for a distinction between actual and ideal body image at the implicit level. The first goal of the present study was to investigate whether self-reported body dissatisfaction is related to implicit measures of actual and ideal body image as captured by the Relational Responding Task (RRT). Secondly, we examined whether these RRT measures were related to several indices of dieting behavior. Women high in body dissatisfaction (n = 30) were characterized by relatively strong implicit I-am-fat beliefs, whereas their implicit I-want-to-be-thinner beliefs were similar to individuals low in body dissatisfaction (n = 37). Implicit body image beliefs showed no added value over explicit body image beliefs in predicting body dissatisfaction and dieting behavior. These findings support the idea that the interplay between ideal and actual body image drives (self-reported) body dissatisfaction. However, strong support for the view that it would be critical to differentiate between explicit and implicit body image beliefs is missing.

Body Dissatisfaction Revisited: On the Importance of Implicit Beliefs about Actual and Ideal Body Image

Body dissatisfaction (i.e., a negative attitude towards one’s own physical appearance) is assumed to originate from a perceived discrepancy between the actual physical appearance (i.e., actual body image) and the desired ideal state of the body (i.e., ideal body image). We assessed implicit beliefs about these two aspects of the body image independently using two Relational Responding Tasks (RRT) in a sample of participants who were either low or high in explicitly reported body dissatisfaction. As hypothesized, differences in body dissatisfaction exerted a differential influence on the two RRT scores. The implicit belief that one is thin was less pronounced in participants who were strongly dissatisfied with their body relative to participants who were more satisfied with their body. The implicit desire to be thin (i.e., thin ideal body image), in contrast, tended to be more pronounced in participants who exhibited a high degree of body dissatisfaction as compared to participants who exhibited a low degree of body dissatisfaction. Hierarchical regression analyses also revealed that the RRT scores were predictive of self-reported body dissatisfaction, even over and above the predictive validity of some (but not all) explicit predictors of body dissatisfaction that were included in the present study. More generally, these findings contribute to the empirical validation of the RRT as a measure of implicit beliefs in the context of body dissatisfaction.

Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: a pilot study

BACKGROUND

Although not part of the diagnostic criteria of the DSM-5, body image disturbance seems to be a relevant feature of Binge Eating Disorder (BED) as well as of other eating disorders such as Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Hence, the aim of the present pilot study was to assess the changeability of body image disturbance in a sample of overweight females with BED by a cognitive-behavioral treatment, directly addressing body image disturbance.

METHOD

Overweight females (N = 34) with BED were randomized to a manualized body image therapy or a waiting-list control group. The final sample consisted of n = 15 participants in the intervention group and n = 19 in the control group due to two drop-outs in the control condition. Before and after the intervention or the waiting period, respectively, participants filled out a questionnaire battery assessing several body image and eating disorder related features. To quantify the perceptual component of body image disturbance, a digital photo distortion technique based on a picture of each participant taken in a standardized suit was applied.

RESULTS

In a two-way ANOVA, significant Time × Group interactions were found for eating and shape concerns, drive for thinness, body dissatisfaction, depressiveness and low self-esteem. Follow-up t-tests indicated a significant symptom reduction of a generally high magnitude in the intervention group. No significant changes concerning body checking and the estimations of one's own "real", "felt" and "ideal" body dimensions were found.

CONCLUSION

The strong symptom reduction in the cognitive-affective component of body image disturbance indicates that an exposure-based cognitive-behavioral body image intervention is a promising treatment module for overweight females with BED, but future research with a larger sample size is needed to quantify possible changes in all components of body image.

Sociocultural and identity predictors of body dissatisfaction in ethnically diverse college women

Emerging research suggests that ethnic identity and American identity are associated with mental health in ethnic minorities and European Americans, respectively. Furthermore, although ethnic identity is associated with diminished body dissatisfaction in minority women, the relationship between American identity and body dissatisfaction is unexplored in all ethnic groups. Accordingly, this study examined the relationships among ethnic identity, American identity, thin-ideal internalization, pressures for thinness, and body dissatisfaction in 1018 ethnically diverse college women. Ethnic identity negatively predicted body dissatisfaction for African Americans, and attenuated the relationship between pressures for thinness and body dissatisfaction for African Americans and Asian Americans, but not European Americans or Latina Americans. Results for American identity were inconclusive. Findings suggest that ethnic identity may be a protective factor against eating pathology for Asian American and African American women.

Ethnic Identity and Implicit Anti-fat Bias: Similarities and Differences between African American and Caucasian Women

Research using self-report or explicit measures of body image suggests African American women have a more accepting view of larger figures than non-Hispanic White (NHW) women. However, increasing research indicates that explicit views may vary from those held at a deeper, implicit level. Our study examined whether African American women held an implicit negative bias toward overweight/fat individuals, despite a greater explicit acceptance of larger body size. Additionally, ethnic identity was measured to assess if strength of identity related to bias. Anti-fat bias was compared within and between ethnic groups using an Implicit Association Test (IAT), which measures the strength of automatic associations between two concepts. This online IAT measured spontaneous thoughts about figures of various body weights (underweight, overweight, obese) and positive and negative terms (eg, attractive and unattractive or healthy and unhealthy). A pervasive anti-fat bias was found in African American as well as NHW women. For both groups, this bias was related to ethnic identity when thinking about figure size and health. Specifically, African American women with lower ethnic identity were more negatively biased and NHW women with higher ethnic identity were more negatively biased. Findings from this study indicate that implicitly there are few differences in the way these two ethnicities classify heavy figures, and therefore African Americans may not be immune to weight stigma. Given the prevalence of obesity and the lack of research on weight stigma among African American women, there is need to address this issue and its impact on well-being.

Obstetric complications and mother's age at delivery are predictors of eating disorder symptoms among Health Science college students

Objective

To identify the association between perinatal/neonatal factors and symptoms of eating disorders among college students.

Methods

Four hundred and eight college students (283 women), aged 18 to 23 years old, enrolled in the first semester of a Bachelor of Health Science degree program were included in the sample. Eating disorder symptoms and body image dissatisfaction were assessed with the Eating Attitudes Test and Bulimic Investigatory Test of Edinburgh. Information regarding birth weight, breastfeeding, obstetric complications, mother’s age at delivery, type of delivery, and birth order were self-reported by the volunteers after consulting their parents. Association between perinatal and neonatal factors and symptoms of anorexia nervosa and bulimia nervosa were assessed by binary logistic regression adjusted for sex, age, and body mass index.

Results

The likelihood of presenting with symptoms of anorexia nervosa was 0.5 time lower for those students born from the oldest mothers (odds ratio – OR=0.37; 95% confidence interval – 95%CI: 0.17-0.83). Relative to bulimia nervosa, the risk was higher among students who reported obstetric complications (OR=2.62; 95%CI: 1.03-6.67).

Conclusion

We observed the association between perinatal and neonatal factors with symptoms of eating disorders in college students.

Implicit beliefs about ideal body image predict body image dissatisfaction

We examined whether implicit measures of actual and ideal body image can be used to predict body dissatisfaction in young female adults. Participants completed two Implicit Relational Assessment Procedures (IRAPs) to examine their implicit beliefs concerning actual (e.g., I am thin) and desired ideal body image (e.g., I want to be thin). Body dissatisfaction was examined via self-report questionnaires and rating scales. As expected, differences in body dissatisfaction exerted a differential influence on the two IRAP scores. Specifically, the implicit belief that one is thin was lower in participants who exhibited a high degree of body dissatisfaction than in participants who exhibited a low degree of body dissatisfaction. In contrast, the implicit desire to be thin (i.e., thin ideal body image) was stronger in participants who exhibited a high level of body dissatisfaction than in participants who were less dissatisfied with their body. Adding further weight to the idea that both IRAP measures captured different underlying constructs, we also observed that they correlated differently with body mass index, explicit body dissatisfaction, and explicit measures of actual and ideal body image. More generally, these findings underscore the advantage of using implicit measures that incorporate relational information relative to implicit measures that allow for an assessment of associative relations only.

The association between internet and television access and disordered eating in a Chinese sample

OBJECTIVE

China has historically reported a low prevalence of eating disorders. However, the rapid social and economic development of this country as well as Western ideals widely disseminated by television and the Internet have led to distinct patterns of behavioral choices that could affect eating disorder risk. Thus, the current study explored the relation between disordered eating and media use.

METHOD

Participants were females from the 2009 wave of the China Health and Nutrition Survey (N = 1,053). Descriptive statistics were obtained and logistic regression models, stratified by age (adolescents ages 12-17 years and adults ages 18-35 years), were used to evaluate the association of media use with disordered eating.

RESULTS

In adolescents, 46.8% had access to the Internet and those with access averaged one hour per day each of Internet and television use. In adults, 41.4% had access to the Internet, and those with access averaged 1 h per day of Internet use and 2 h per day of television use. Internet access was significantly associated with a subjective belief of fatness (OR = 2.8, 95% CI: 1.6, 4.9) and worry over losing control over eating (OR = 4.8, 95% CI: 2.3, 9.8) only in adults.

DISCUSSION

These findings help characterize the overall pattern of media use and report of eating disorder symptoms in a large sample of female Chinese adolescents and adults. That Internet access in adults was significantly associated with disordered eating cognitions might suggest that media access negatively influences these domains; however, more granular investigations are warranted.

Implicitly assessed attitudes toward body shape and food: the moderating roles of dietary restraint and disinhibition

BACKGROUND

Attitudes toward body shape and food play a role in the development and maintenance of dysfunctional eating behaviors. Nevertheless, they are rarely investigated together. Therefore, this study aimed to explore the interrelationships between implicitly assessed attitudes toward body shape and food and to investigate the moderating effect on these associations of interindividual differences in problematic and nonproblematic eating behaviors (i.e., flexible versus rigid cognitive control dimension of restraint, disinhibition).

METHODS

One hundred and twenty-one young women from the community completed two adapted versions of the Affect Misattribution Procedure to implicitly assess attitudes toward body shape (i.e., thin and overweight bodies) and food (i.e., "permitted" and "forbidden" foods), as well as the Three-Factor Eating Questionnaire to evaluate restraint and disinhibition.

RESULTS

The results revealed that an implicit preference for thinness was positively associated with a positive attitude toward permitted (i.e., low-calorie) foods. This congruence between implicitly assessed attitudes toward body shape and food was significant at average and high levels of flexible control (i.e., functional component of eating). Moreover, an implicit preference for thinness was also positively associated with a positive attitude toward forbidden (i.e., high-calorie) foods. This discordance between implicitly assessed attitudes was significant at average and high levels of rigid control and disinhibition (i.e., dysfunctional components of eating).

CONCLUSIONS

These findings shed new light on the influence of congruent or discordant implicitly assessed attitudes toward body shape and food on normal and problematic eating behaviors; clinical implications are discussed.

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n=268), Asian American (n=163), Latina (n=146), and African American (n=73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.

Association of thin-ideal media exposure, body dissatisfaction and disordered eating behaviors among adolescents in Taiwan

OBJECTIVE

The present study examined the relationships between thin-ideal media exposure, body dissatisfaction, and disordered eating behaviors among adolescents in Taiwan.

METHOD

A total of 2992 students in the 10th grade were recruited from 26 high schools in Taipei, Taiwan to complete a questionnaire in 2010.

RESULTS

The results showed that the adolescents were exposed to thin-ideal messages a few times a week. Females had higher levels of thin-ideal media exposure, media pressure to be thin, thin-ideal internalization, body dissatisfaction, and disordered eating behaviors than males. Multivariate logistic regression results indicated that media pressure and thin-deal internalization significantly increased the likelihood of body dissatisfaction, while media pressure and body dissatisfaction contributed to both restrained eating and unhealthy weight control behaviors, when all other variables were controlled for.

Thinness expectancies and restraint in Black and White college women: a prospective study

Despite stereotypes to the contrary, women of diverse racial backgrounds, including Black women, experience disordered eating symptoms. While there has been an increase in research comparing disordered eating symptoms across ethnic groups, there remains a dearth of research on the mechanisms of action underlying the development of these symptoms in non-White populations. Thinness expectancies prospectively predict disordered eating symptoms in adolescent girls, but the majority of research on expectancies has been conducted with White samples. Restraint, or self-initiated attempts to restrict food intake, may be precipitated by cognitive factors such as thinness expectancies. In the current study, we followed a sample of Black and White women over one semester of college to assess the influence of thinness expectancies and ethnic identity on restraint. Our sample consisted of 193 college women (93 Black women). We found that White women experienced restraint at higher levels than Black women, but both Black and White women experienced an increase in restraint across the first semester in college. The endorsement of thinness expectancies added significant incremental variance to the prediction of restraint over time, when baseline restraint was included in the model. These effects were not moderated by ethnicity nor ethnic identity. This study adds to the scarce literature on phenomenology of disordered eating in Black women.

[Body satisfaction and diet quality in female university students from the Basque Country]

The aim of this study was to analyze the body weight satisfaction and the diet quality in a group of female university students and to assess the differences between degrees in different fields of knowledge. Participants were 47 women volunteers classified as normal weight, 29 from the degree in Human Nutrition and Dietetics and 18 from the degree in Social Work. Dietary intake was evaluated by a validated food frequency questionnaire. This information was used to estimate the Diet Quality Index. Recalled weight and desired weight were used to measure weight satisfaction. Furthermore, lifestyle variables were registered. Data were analyzed using SPSS vs 17.0. The proportion of students who were satisfied with their body weight was 27.7%, 57.4% were dissatisfied and 14.9% very dissatisfied. Differences between degree courses were not found in weight satisfaction classification. The mean Diet Quality Index was 38.5±6.7, and 83% of participants had a diet classified as "needs to improve". Human Nutrition and Dietetics students had higher Diet Quality Index scores (41.5±5.1) than Social Work students (33.7±6.5) (p<0.001). In conclusion, a large proportion of participants were dissatisfied with their body weight and they wished to weigh less than current weight values. It seems that the knowledge of Nutrition university student participants affects their food practice, but this is not enough to achieve a healthy diet and to reduce their body dissatisfaction.