Using an app to count calories: Motives, perceptions, and connections to thinness- and muscularity-oriented disordered eating

Exploring weight-related self-monitoring as a potential risk factor for eating disorder symptoms in adults - A systematic review and meta-analysis

OBJECTIVE

Weight-related self-monitoring (WRSM), which involves the intentional tracking of body weight metrics, has been considered a potential risk factor for eating disorders. Therefore, the aim of this study was to systematically summarize the current state of the literature and to quantify the possible association between WRSM and eating disorder symptoms in adults.

METHOD

Preregistration was carried out using PROSPERO (ID CRD42022366133). The PubMed, PsycInfo, and Web of Science databases were searched until December 21, 2023. A study had to be 1) be available in English or German, 2) be peer-reviewed and quantitative, 3) include adult participants (age ≥18 years) from the general population, 4) assess eating disorder symptoms via at least one of the following questionnaires: EDI, EAT, FEV, TFEQ, DEBQ, EDE-Q, Munich ED-Quest or IEG, and 5) include WRSM. Data analyses included descriptive analyses and three-level meta-analysis, corrected for correlations, for the global score and the different subscales of the eating disorder questionnaires.

RESULTS

A total of 28 studies (n = 17,370 participants), with an overall fair methodological quality, were included in the systematic review. Out of these studies, nine studies with n = 13,507 participants were ultimately analyzed in the meta-analysis. The three-level meta-analysis did not reveal a significant association between WRSM and the eating disorder global score (r = 0.13, 95% CI [-0.02, 0.28]; p = 0.08), with this pattern also being evident in the subgroup analysis (diet monitoring).

DISCUSSION

WRSM alone does not generally translate into an increased risk of disordered eating symptoms in the general population. We assume that individual factors are likely to determine whether the use of WRSM could lead to eating disorder symptoms. These factors should be accounted for in future research.

Negative emotional eating patterns in general Chinese adults: A replication and expansion study examining group differences in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties

Previous research identified four patterns of negative emotional eating in American and Chinese university students and proposed future directions (e.g., exploring potential differences in emotion regulation across patterns and replicating the patterns in a general, non-student population). Furthermore, prior research has not explored group differences in muscularity-oriented eating disorder symptomatology or psychosocial impairment. Therefore, the present study addressed these gaps in a sample of general Chinese adults, further testing group differences in typical and muscularity-oriented eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties across patterns of negative emotional eating. A total of 600 Chinese adults were recruited. Latent class analysis (LCA) was used. Results replicated the four patterns of negative emotional eating in previous research, including non-emotional eating (non-EE), emotional over- and under-eating (EOE-EUE), emotional over-eating (EOE), and emotional under-eating (EUE). Significant class differences were identified in eating disorder symptomatology, psychosocial impairment, and emotion regulation difficulties. Specifically, individuals with EOE and EOE-EUE patterns exhibited higher eating disorder symptomatology, higher psychosocial impairment, and more emotion regulation difficulties than those with non-EE and EUE patterns. Therefore, these two classes (i.e., EOE and EOE-EUE), especially the poorly researched EOE-EUE group, should be further examined to elucidate research and clinical applications. Furthermore, findings underscore the role of emotion regulation difficulties in further describing the differences across these negative emotional eating patterns, which can be considered in future interventions for reducing negative emotional eating.

Exploring the associations between muscularity teasing and eating and body image disturbances in Chinese men and women

This study described muscularity teasing in both men and women and explored its associations with eating and body image disturbances in adults from China. A total of 900 Chinese adults (50% women) were recruited online. Correlation and regression analyses were conducted to examine the relationships between muscularity teasing and a battery of measures on eating and body image disturbances. Gender differences in the associations were examined. Men reported more muscularity teasing than women (31.6% men vs. 15.6% women; χ2(1,N = 900) = 31.99, p < .001). Muscularity teasing was significantly and positively correlated with all measures in both men and women. Muscularity teasing explained significant, unique variance in all measures for men and women, except for body fat dissatisfaction in women, beyond covariates (i.e., age, body mass index, and weight teasing). The relationships between muscularity teasing and eating and body image disturbances were generally stronger in men than women. Findings further suggest that muscularity teasing is an important factor related to eating and body image disturbances in men and women, but muscularity teasing might be more detrimental to men's eating behaviors and body image. Future research is needed to further explore the directionality and mechanisms of the links between muscularity teasing and eating and body image disturbances.

Predictors of Food and Physical Activity Tracking Among Young Adults

BACKGROUND

Monitoring food intake and physical activity (PA) using tracking applications may support behavior change. However, few longitudinal studies identify the characteristics of young adults who track their behavior, findings that could be useful in designing tracking-related interventions. Our objective was to identify predictors of past-year food and PA tracking among young adults.

METHODS

Data were available for 676 young adults participating in the ongoing longitudinal Nicotine Dependence in Teens Study. Potential predictors were measured in 2017-2020 at age 31, and past-year food and PA tracking were measured in 2021-2022 at age 34. Each potential predictor was studied in a separate multivariable logistic regression model controlling for age, sex, and educational attainment.

RESULTS

One third (37%) of participants reported past-year PA tracking; 14% reported past-year food, and 10% reported both. Nine and 11 of 41 potential predictors were associated with food and PA tracking, respectively. Compensatory behaviors after overeating, trying to lose weight, self-report overweight, reporting a wide variety of exercise behaviors, and pressure to lose weight predicted both food and PA tracking.

CONCLUSION

Food and PA tracking are relatively common among young adults. If the associations observed herein between compensatory behavior after overeating and tracking (among other observed associations) are replicated and found to be causal, caution may need to be exercised in making "blanket" recommendations to track food intake and/or PA to all young adults seeking behavior change.

Smartphone and Instagram use, body dissatisfaction, and eating disorders: investigating the associations using self-report and tracked data

BACKGROUND

Previous research has linked smartphone and Instagram use to higher body dissatisfaction (BD) as well as eating disorder (ED) symptomatology. However, these studies have typically been limited to using self-report measures for technology use which, as shown by scientific literature, might not be reliable. In the present work, we combine self-reported assessments as well as tracked smartphone and Instagram use.

METHODS

The effective sample comprised N = 119 women (34 with ED diagnosis history) who were queried about BD and ED symptomatology, and who provided the data about their smartphone and Instagram use duration for each day of the previous week.

RESULTS

The study results show that women with an ED diagnosis history scored higher on both BD as well as ED scales. Although women with an ED diagnosis history had higher smartphone screen time, there were no statistically significant differences in Instagram screen time. Tracked smartphone use duration was positively correlated with both BD and ED symptomatology, but the role of Instagram use needs to be further elucidated.

CONCLUSIONS

The results of this study show that while BD and ED symptomatology are correlated with smartphone use, it may be that Instagram use is not the main contributor to that relationship.

Exploring the effects of gender and sexual orientation on disordered eating: an EFA to CFA study of the Eating Disorder Examination Questionnaire

Several problems limit our understanding of the ways that gender and sexual orientation influence disordered eating. These include the reliance on measures that have been developed and validated in samples of cisgender heterosexual women, and the lack of confirmed measurement invariance that allows us to meaningfully compare these experiences between groups. This study was an EFA to CFA exploration of the Eating Disorder Examination Questionnaire in a group of heterosexual, bisexual, gay, and lesbian men and women. In total 1638 participants were recruited via adverts in traditional and social media to complete an online survey. A 14-item, three-factor model of the EDE-Q was confirmed as best fitting the data and measurement invariance between groups was ascertained. Sexual orientation influenced disordered eating and muscularity-related thoughts and behaviours in men but not women. Heterosexual men reported more muscularity-related concerns and behaviours, whereas gay men showed more thinness-related concerns and behaviours. Bisexual participants showed a different pattern, highlighting the importance of treating this group individually and not collating all non-heterosexual participants together. Small but significant effects of sexual orientation and gender have an impact on the kinds of disordered eating thoughts and behaviours one might experience, and could influence prevention and treatment. Clinicians may be able to provide more effective and tailored interventions by taking into account gender and sexual orientation in sensitive ways.

A Tailored and Engaging mHealth Gamified Framework for Nutritional Behaviour Change

Mobile health applications (apps) have been shown to be effective for improving eating habits. However, most of the existing apps rely on calorie and nutrient counting which have several limitations including the difficulty in sustaining long-term use, inaccuracy, and the risk of developing eating disorders. We designed and developed a mHealth framework for nutritional behaviour change, integrated into the CarpeDiem app, that focuses on the intake of key food groups which are known to have a higher impact on health indicators instead of the intake of nutrients. This framework is mainly based on a gamified system that delivers personalized dietary missions to the user and provides motivational recommendations that help the user to achieve these missions. Its design was guided by an evidenced-based theory of behavioural change, the HAPA model, and it is also characterized by the personalization of the system and the use of a recommender system based on advanced artificial intelligence techniques. Overall, the approach used in the present app could foster a sustained improvement of eating habits among the general population, which is the main challenge of dietary interventions, decreasing the risk of developing the chronic diseases associated with unhealthy dietary habits.

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

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

Validation of the muscularity-oriented eating test in adult women in China

OBJECTIVE

Research on muscularity-oriented disordered eating has grown in recent years. However, the bulk of this research has focused on men and Western populations. Limited research is available in non-Western populations of women (e.g., China) which is likely due to the lack of valid instruments in these populations. Thus, the current study aimed to describe the validity and reliability of the Muscularity-Oriented Eating Test (MOET) in Chinese women.

METHOD

Two online surveys (survey one: n = 599, M_age = 29.49, SD = 7.36; survey two: n = 201, M_age = 28.42, SD = 7.76) were conducted to explore the psychometric properties of the MOET in Chinese women. In survey one, the factor structure of the MOET was examined via exploratory and confirmatory factor analyses (EFA and CFA). Internal consistency reliability and convergent and incremental validity of the MOET were also assessed. In survey two, test-retest reliability across a 2-week interval was examined.

RESULTS

EFA and CFA provided support for the unidimensional factor structure of the MOET in Chinese adult women. The MOET presented good internal consistency and test-retest reliability and convergent validity via large, positive associations with theoretically related constructs (e.g., thinness-oriented disordered eating, drive for muscularity, and psychosocial impairment). Finally, muscularity-oriented disordered eating described unique variance in psychosocial impairment, providing support for the incremental validity of the MOET.

DISCUSSION

The sound psychometric structure of the MOET was supported in Chinese women. Continued research is needed to describe muscularity-oriented disordered eating in Chinese women to contribute to this significant gap in the literature.

PUBLIC SIGNIFICANCE

The Muscularity-Oriented Eating Test (MOET) is a measure specifically developed for assessing muscularity-oriented disordered eating. This study examined the validity and reliability of the MOET in Chinese women. The results showed that the MOET had sound validity and reliability in Chinese women. Thus, the MOET is a valuable tool for advancing the understanding of the muscularity-oriented disordered eating of women from the Chinese context.

The use of technology in the treatment of youth with eating disorders: A scoping review

BACKGROUND

Adolescence and young adulthood is a high-risk period for the development of eating disorders. In recent years, there has been an increase in use of technology-based interventions (TBIs) for the treatment of eating disorders. The objective of this study was to determine the types of technology used for eating disorder treatment in youth and their effectiveness.

METHODS

A scoping review was conducted according to PRISMA-ScR guidelines. Four databases were searched. Eligible articles included: (1) a TBI (2) participants with a mean age between 10- and 25-years and meeting DSM-IV or DSM-5 criteria for any eating disorder and (3) qualitative or quantitative designs. Quantitative and qualitative studies were assessed for quality.

RESULTS

The search identified 1621 articles. After screening of titles and abstracts, 130 articles were read in full and assessed for eligibility by two raters. Forty-nine (29 quantitative and 20 qualitative, observational, or mixed methods studies) met inclusion criteria. Quality ratings indicated that 78% of quantitative studies had a low risk of bias and 22% had a moderate risk. Technologies reviewed in our study included videoconference therapy, mobile applications, and online self-help. We considered interventions used both within sessions with clinicians as well as those used in between sessions by patients alone. Fifteen of 18 (83%) quantitative studies found that TBIs reduce eating disorder symptomatology, with nine of those reporting medium-to-large effect sizes. Qualitative data was of high quality and suggested that virtual interventions are acceptable in this population.

CONCLUSIONS

Although identified studies are of high quality, they are limited in number. More research is needed, particularly regarding videoconferencing and mobile applications. Nonetheless, TBIs show promise for the treatment of eating disorders in youth.

TRIAL REGISTRATION

Not applicable.

Association between muscle dysmorphia psychopathology and binge eating in a large at-risk cohort of men and women

BACKGROUND

Current research on muscle dysmorphia (MD) has focused on restrained eating behaviors and has adopted a primarily male perspective. Despite initial evidence, the role of possible binge eating associated with MD has only been scarcely investigated. To extend the transdiagnostic and cross-gender approaches and address the dearth in research related to MD, this study investigated the association between MD psychopathology and binge eating in men and women.

METHODS

This study investigated the association between MD psychopathology and binge eating in both men and women. Participants were a sample of 5905 men (n = 422) and women (n = 5483) social media users aged 18-72 years. They completed an online survey that included self-report measures assessing demographics, binge eating, MD psychopathology, and drive for thinness and leanness. Binge eating was assessed using the diagnostic questions of the validated German version of the Eating Disorder Examination-Questionnaire. The Muscle Dysmorphic Disorder Inventory (MDDI) was used to assess MD psychopathology. A total score of > 39 was set as a cutoff to define an "MD at-risk" state for both men and women. Hierarchical logistic regression analysis was used to analyze the association between MD psychopathology and binge eating.

RESULTS

MD psychopathology was significantly positively associated with binge eating in both men and women. Among the three MDDI subscales, only appearance intolerance was significantly associated with MD, and drive for size and functional impairment were not associated. MD at-risk status yielded a predicted probability of binge eating of 25% for men and 66.9% for women. The increased probability of binge eating associated with MD at-risk status was mainly accounted for by appearance intolerance in men and drive for thinness in women.

CONCLUSION

MD psychopathology is positively associated with binge eating in both men and women. Binge eating episodes should therefore form part of the clinical assessment of MD.

Validation and measurement invariance of the muscularity-oriented eating test among Brazilian men and women

OBJECTIVE

The Muscularity-Oriented Eating Test (MOET) is a 15-item unidimensional scale, designed to assess eating practices that occur in the pursuit of a muscular body. The aim of the present study was to describe the translation and cultural adaptation of the MOET to Brazilian Portuguese, to explore its factor structure and measurement invariance, and to evaluate its internal consistency, three-week test-retest reliability, and convergent validity in a community sample of Brazilian men and women.

METHOD

After the back-translation procedure, the Brazilian MOET was administered online to a sample of 1246 adults (634 men and 612 women), along with measures of drive for muscularity, muscle dysmorphia symptoms, muscular/athletic-ideal internalization, disordered eating behaviors, and exercise dependence.

RESULTS

Findings from an exploratory factor analysis and a confirmatory factor analysis revealed a one-factor structure and adequate internal consistency for men (ω = 0.86; α = 0.86) and women (ω = .84; α = .83). Measurement invariance across gender was supported. In addition, the scale demonstrated good three week test-retest reliability for both men (ICC = .96; p < .001) and women (ICC = .92; p < .001), and the subscales revealed moderate to large associations with drive for muscularity, muscle dysmorphia symptoms, muscular/athletic-ideal internalization, disordered eating, and exercise dependence.

CONCLUSION

This study supports the validity and reliability of the MOET in a community sample of Brazilian men and women and represents an advance in measures of muscularity-oriented disordered eating in Brazilian adults, allowing for future cross-cultural studies in this field.

PUBLIC SIGNIFICANCE

The Muscularity-Oriented Eating Test (MOET) is a measure of muscularity-oriented disordered eating, which assess strict adherence to diet rules, including the food's macronutrient content, regulation of protein intake, and eating less or more to influence muscle gain. This study evaluated the validity and reliability of the MOET in a community sample of Brazilian men and women. Our findings represent an advance in measures of muscularity-oriented disordered eating in Brazilian adults.