Drive for thinness and fear of fat: separate yet related constructs?

Pressures to be "shedding for the wedding": An evaluation of the tripartite influence model of disordered eating and body dissatisfaction among engaged women

Disordered eating and body image concerns are particularly prevalent among women who are engaged to be married (i.e., brides-to-be), and this population may be subject to increased social and cultural pressure to achieve specific appearance ideals. The tripartite influence model purports that appearance pressures from four sources (peers, family, romantic partners, and media) influence body image and disordered eating outcomes through thin ideal internalization and appearance comparison. The present cross-sectional study sought to examine the relationships between tripartite theory constructs, body image, and disordered eating among 329 brides-to-be using path analysis with robust estimation. In the final model, media influence was the only tripartite predictor associated with both thin ideal internalization and appearance comparison. Further, thin ideal internalization and appearance comparison were associated with disordered eating directly as well as indirectly through body dissatisfaction. Altogether, the influence variables explained 39 % of the variance in disordered eating. While appearance pressures from media, peers, and partners were indirectly associated with disordered eating through one or more hypothesized indirect pathways, appearance pressure from family was not, indicating this relationship may be uniquely impacted by other factors not captured in tripartite models. Results suggest that family and media influence are most strongly associated with disordered eating in this group and have the capacity to inform future research as well as intervention development and dissemination.

Appearance between professionalism and work-related stress among marketing employees

BACKGROUND

Appearance and body language are key components of non-verbal communication and play an important role in the service and marketing sector.

OBJECTIVE

The aim was to explore experiences and perceptions of appearance issues related to work among employees in the marketing sector in Sweden.

METHODS

Interviews were conducted with 15 marketing and communication employees (five males, ten females), at multinational companies and a university. Thematic analyses were conducted, and content was organised in two themes with sub-themes: 1. Appearance from a resource perspective (Appearance benefits; Physical activity resources; Age benefits). 2. Appearance from a demand perspective (Adaptation to gender roles; Investment in appearance; Adaptation to situation and culture).

RESULTS

The findings showed that appearance was perceived as a resource for professionalism, work engagement and career in various ways. Appearance-related issues were not considered on organisational work level, but employees perceived unspoken demands to look good and appropriate to represent the company brand. The employees spent a considerable amount of time, money, and effort on appearance.

CONCLUSION

Appearance creates dualistic questions and points out several dilemmas that the individual struggle to solve, which creates stress in work. The character of unspoken demands on appearance and absent communication on organisational level make the stress-coping strategies complicated and the stress coping is mostly left for the individual to handle. A gender difference shows that compared to men, women more often experience negative stress generated by appearance-related issues in work. Education and actions at the managerial level of companies are needed.

The Association of Perceived Vulnerability to Disease with Cognitive Restraint and Compensatory Behaviors

Individual differences exist in perceived vulnerability to disease (PVD). PVD is associated with negative responses (e.g., disgust) towards individuals with obesity and heightened sensitivity regarding personal appearance. Through increasing fear of fat (FOF), PVD may be associated with cognitive restraint and compensatory behaviors. We utilized an adult sample (n = 247; 53.3% male sex assigned at birth) recruited through Amazon's MTurk prior to the COVID-19 pandemic to investigate associations between PVD, cognitive restraint and compensatory behaviors. Participants completed the Perceived Vulnerability to Disease Scale, Eating Disorder Diagnostic Scale, Dutch Eating Behaviors Questionnaire, and Goldfarb's Fear of Fat Scale. Mediation analyses were used to test our hypotheses. Perceived infectability (PVD-Infection) was associated with cognitive restraint and compensatory behaviors through increased FOF. Perceived germ aversion (PVD-Germ) was associated with cognitive restraint, but FOF did not mediate this association. Sex-stratified analyses revealed no significant sex differences. PVD may be an overlooked factor associated with cognitive restraint and compensatory behaviors in males and females. FOF was an important mediating factor in these associations. Increased engagement in cognitive restraint and compensatory behaviors may reflect attempts to reduce FOF. Future longitudinal research should explore whether PVD is a risk factor for cognitive restraint and compensatory behaviors.

A qualitative investigation of the phenomenology of muscle dysmorphia: Part 1

Muscle dysmorphia (MD) is a psychological disorder defined by preoccupation with one's perceived lack of muscularity and/or leanness, causing significant functional impairment. Studies of individuals with diagnosed MD are rare and no large-scale qualitative studies of the disorder exist. We conducted a qualitative study exploring the lived experiences of 29 individuals with diagnosed MD. Using reflexive thematic analysis, we generated five themes capturing the core features of MD. We identified two distinct phenotypes of MD: a "muscular/lean phenotype" focused on both gaining muscle and remaining lean, and a "muscular phenotype" with a sole preoccupation of increasing muscle mass. Participants also described their physique goals as never-obtained "moving goalposts", differed in their desire for muscularity versus leanness, and experienced fluctuations in body dissatisfaction during "cutting" versus "bulking" phases, and pre- versus post-workout. Almost all participants reported avoiding public body exposure and compulsively mirror-checking. Most were rigorous dieters who meticulously tracked their caloric and macronutrient intake, and were obsessive about meeting protein targets. Disruptions to dieting and training were often minimised by compromising their social lives. Low self-esteem appeared a predisposing factor for MD, while social comparison, body image distortion, and integration of MD into one's self-identity may represent maintaining factors. Additional clinically valuable insights into MD's phenomenology are discussed in detail.

Associations between eating disorder symptoms and smoking and vaping use and motives in college students

A positive association between eating disorder (ED) symptoms and cigarette use exists. However, little is known about the association between ED symptoms and e-cigarette use, as well as how these symptoms are related to motives for using cigarettes and e-cigarettes. In this study, 716 college students (M age = 19.23, SD = 1.65; 61 % female) completed an online survey that included the Eating Pathology Symptoms Inventory, smoking and vaping questionnaires, and the Drinking Motives Questionnaire-Revised, which was modified for smoking and vaping. We examined mean differences in ED symptoms in lifetime (and past-month) cigarette and e-cigarette users versus non-users, and investigated correlations between ED symptoms and smoking and vaping motives. Finally, we evaluated whether biological sex influenced the results. Overall, 30.4 % of students reported lifetime smoking, 10.5 % reported past-month smoking, 23 % reported lifetime vaping, and 9.5 % reported past-month vaping. With the exception of higher mean scores for negative attitudes toward obesity in students reporting lifetime smoking versus never smoking after adjusting for sex (M = 5.97 vs. M = 4.52, t[713] = -3.76, q = 0.004), no significant mean differences emerged between those who used nicotine and those who did not, which reflected small to moderate effect sizes. Few associations were observed between ED symptoms and nicotine use motives. These findings suggest that the comorbidity between ED symptoms and smoking and vaping in a non-clinical sample is minimal, although additional research with larger sample sizes of males and females is needed.

Integrating fear of fatness into sociocultural models of body image and eating concerns

To date, sociocultural models of body dissatisfaction and disordered eating have predominantly focused on the pursuit of thinness and have somewhat neglected sociocultural discourse and pressures that increase fear of fatness. Therefore, we tested a model to determine whether sociocultural pressures from media and interpersonal sources were associated with drive for thinness and fear of fatness. We also examined whether beliefs about the controllability of shape and weight were in turn associated with body dissatisfaction and disordered eating. A sample of N = 226 female undergraduate students in the U.S. completed an online survey assessing the variables of interest. After minor modification to the model pathways, the model provided a good fit to the data. Sociocultural influences to pursue thinness and fear fat related to body dissatisfaction and disordered eating through internalization of the thin-ideal and fear of fat. Together, these findings suggest that the pursuit of thinness and fear of fatness are distinct elements in etiologic models of body dissatisfaction and disordered eating. Additional work, including longitudinal research and studies among more diverse groups of individuals, is warranted to further clarify these relationships.

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.

An examination of the factor structure of the Goldfarb Fear of Fat Scale in clinical and non-clinical samples of Polish women

Although associations between fear of fat and eating disorders (ED) have been frequently studied, it appears that the construct of fear of fat requires in-depth understanding to determine whether it is similar in individuals diagnosed with bulimia nervosa, anorexia nervosa, and individuals from the general population. The purpose of our study was to confirm the factor structure of the Goldfarb Fear of Fat Scale (GFFS) in clinical and non-clinical settings. This issue has not yet been investigated in the literature. Data were collected from 126 female patients diagnosed with ED and a total of 581 women from the general population. Our findings are highly consistent with the original single-factor structure of GFFS but only in the clinical sample. In the non-clinical sample, a good fit to the data has been achieved with a two-factor model composed of Fear of gaining weight and Fear of losing control over eating/weight. The Polish version of GFFS demonstrated good psychometric properties. It can be used as a fast screening tool to identify individuals with eating disorders and those at risk of developing such disorders. We recommend the two-factor model for non-clinical samples and the one-dimensional model for clinical samples for both research and practice.

Using individual networks to identify treatment targets for eating disorder treatment: a proof-of-concept study and initial data

BACKGROUND

Eating disorders (EDs) are severe mental illnesses, with high morbidity, mortality, and societal burden. EDs are extremely heterogenous, and only 50% of patients currently respond to first-line treatments. Personalized and effective treatments for EDs are drastically needed.

METHODS

The current study (N = 34 participants with an ED diagnosis collected throughout the United States) aimed to investigate best methods informing how to select personalized treatment targets utilizing idiographic network analysis, which could then be used for evidence based personalized treatment development. We present initial data collected via experience sampling (i.e., ecological momentary assessment) over the course of 15 days, 5 times a day (75 total measurement points) that were used to select treatment targets for a personalized treatment for EDs.

RESULTS

Overall, we found that treatment targets were highly variable, with less than 50% of individuals endorsing central symptoms related to weight and shape, consistent with current treatment response rates for treatments designed to target those symptoms. We also found that different aspects of selection methods (e.g., number of items, type of centrality measure) impacted treatment target selection.

CONCLUSIONS

We discuss implications of these data, how to use idiographic network analysis to personalize treatment, and identify areas that need future research.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04183894. Registered 3 December 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04183894 . NCT04183894 (ClinicalTrials.gov identifier).

Changing your body changes your eating attitudes: embodiment of a slim virtual avatar induces avoidance of high-calorie food

The virtual-reality full-body illusion paradigm has been suggested to not only trigger the illusory ownership of the avatar's body but also the attitudinal and behavioral components stereotypically associated to that kind of virtual body. In the present study, we investigated whether this was true for stereotypes related to body size: body satisfaction and eating control behavior. Healthy participants underwent the full-body illusion paradigm with an avatar having either a larger or a slimmer body than their own, and were assessed for implicit attitudes towards body image and food calorie content at baseline and after each full-body illusion session. Results showed that the illusion emerged regardless of the avatar's body size, whereas the perceived dimension of the own body size changed according to the avatar's body size (i.e., participants felt to be slimmer after embodying their slim avatar and larger after embodying their large avatar). Crucially, we found that implicit attitudes towards food, but not those towards one's own body, were modulated by the size of the virtual body. Compared to baseline, ownership of a slimmer avatar increased the avoidance of high-calorie food, whereas ownership of a larger avatar did not induce changes. Our findings suggest that the illusory feeling of being slimmer drives also the food-related stereotypes associated with that body size, increasing the regulation of eating behaviors.

Development and validation of the Sociocultural Influences on Fear of Fat Scale (SI-FAT)

The stigmatization of larger bodies is omnipresent in Western society and may be associated with fear of fat, one of the core elements of body image and eating concerns. To date, while much work has focused on sociocultural influences towards thinness, parallel work exploring sociocultural influence on fear of fat is lacking. This study therefore aimed to develop and evaluate a measure of sociocultural influences on fear of fat (SI-FAT). Study 1 included N = 235 women, mean (SD) age = 19.75 (1.35) years; a subsample of whom provided additional data two-weeks later (n = 140). Exploratory factor analyses supported a four-factor structure with 4-item media, peer, family, and partner subscales. These subscales revealed excellent internal and test-rest reliability. In addition, support for convergent validity with body dissatisfaction, fear of fat, and rigid dietary control emerged. Study 2, among N = 317 women, 19.82 (SD = 1.5) years, further supported the factor structure and provided additional evidence of convergent validity with weight-based teasing, divergent validity with anti-fat attitudes, and incremental validity in the prediction of dietary restriction above and beyond anti-fat bias. Together, findings suggest that the SI-FAT is a useful tool for assessing sociocultural influences on fear of fat.

Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery

OBJECTIVE

This study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery.

METHOD

Five female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA).

RESULTS

Three super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences-including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours.

DISCUSSION

This study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m² but are severely restricting energy intake.

Assessment of approach-avoidance tendencies in body image using a novel touchscreen paradigm

BACKGROUND AND OBJECTIVES

Approaching the thin-ideal and avoiding the stigma of fatness are motivational tendencies resulting from the internalisation of sociocultural appearance norms. Individual differences in subclinical levels of eating disorder symptomatology may be related to variation in motivational tendencies regarding thin vs. non-thin bodies.

METHODS

To empirically investigate this hypothesis, the current study employed a novel touchscreen approach-avoidance task with the capacity to effectively simulate compatible approach-avoidance movements. Eighty-four undergraduate females pulled closer or pushed away images depicting either bodies or objects, in response to weight category (underweight bodies vs. overweight bodies) and object category (kitchen items vs. office tools), by means of arm movements.

RESULTS

Unexpectedly, results revealed relatively faster approach of overweight bodies and relatively faster avoidance of underweight bodies. Moreover, speeded approach towards overweight bodies, relative to underweight bodies, correlated positively with elevated eating disorder symptomatology.

LIMITATIONS

The current sample was restricted to undergraduate women.

CONCLUSIONS

The current study provides initial evidence for the utility of a touchscreen-based measure of approach-avoidance tendencies in body image, albeit comparison with other bias assessments would be necessary. Moreover, our findings suggest that a greater tendency to approach overweight bodies is associated with elevated eating disorder symptomatology. Future extensions of the current work are necessary to clarify the function of motivational tendencies in the body image context.

Fear of fat and restrained eating: negative body talk between female friends as a moderator

PURPOSE

This study examined whether engagement in negative body talk would moderate the association between fear of fat and restrained eating among female friend dyads.

METHODS

Female friends (N_pairs = 130) were recruited from a Midwestern university in the United States. The dyadic data were examined with an Actor-Partner Interdependence Model (APIM).

RESULTS

Results showed that women's fear of fat was significantly related to their own restrained eating behaviors. In contrast, women's fear of fat was not significantly related to their friends' restrained eating behaviors. Negative body talk was significantly related to restrained eating, as reported by both friends. The interaction between negative body talk and women's own fear of fat was found to be significant. Although women with less fear of fat showed less restrained eating, engaging in more negative body talk with a friend increased their engagement in restrained eating. Women with more fear of fat engaged in more restrained eating, regardless of their engagement in negative body talk.

CONCLUSION

Given the detrimental role of body talk between fear of fat and restrained eating, interventions may target reducing body talk among young women.

NO LEVEL OF EVIDENCE FOR

Basic science, Animal study, Cadaver study, and Experimental study articles.

The importance of motivational orientation towards the muscular ideal versus the stigmatised burdensome body in male body dissatisfaction

Internalisation of the muscular ideal is a vulnerability factor for body dissatisfaction in males. It is unclear, however, whether body dissatisfaction results from approach towards the muscular ideal versus fear of the stigmatised burdensome body. The current study sought to address this gap by assessing both approach and avoidance motivation regarding muscular and non-muscular bodies, respectively, and evaluating the unique associations between approach-avoidance tendencies and body dissatisfaction. Eighty-three male undergraduate students completed an implicit measure of approach-avoidance tendencies, the Stimulus Response Compatibility task, and a self-report measure of trait body dissatisfaction. Results revealed that participants were quicker to approach than to avoid muscular bodies; however, there were no differences in approach vs. avoidance tendencies regarding non-muscular bodies. Furthermore, in a multiple regression model comprising motivational bias scores regarding muscular and non-muscular bodies, only an approach bias towards muscular bodies predicted unique variance in body dissatisfaction. These findings are novel in showing an implicit approach motivation towards the muscular ideal in male undergraduates. Furthermore, in this population, motivational orientation towards the muscular ideal, versus the stigmatised burdensome body, seems to be more tightly associated with body dissatisfaction.

A network approach to eating disorder symptomatology: Do desire for thinness and fear of gaining weight play unique roles in the network?

This study used network analyses to test the hypotheses that desire for thinness and fear of gaining weight are related but distinct constructs that play a central role in disordered eating. Data from a sample of 251 college women were used. Sparse undirected eating disorder symptom networks were calculated. Bootstrapped difference tests for edge weights and centrality indices were used to compare the position of desire for thinness and fear of gaining weight. Desire for thinness and fear of gaining weight exhibited unique patterns of associations within the network. Desire for thinness was highly connected to body dissatisfaction, thoughts about dieting, and thoughts about binge eating. Fear of gaining weight was not. Desire for thinness emerged as the most central symptom. Our findings support the distinction between fear of gaining weight and desire for thinness and their different roles within the eating disorder symptom network.

Fear of fatness and drive for thinness in predicting smoking status in college women

Recent research has identified fear of fatness (FF) as a related yet distinct construct from drive for thinness (DT). Whereas DT may be associated with need for approval and an "approach" tendency, FF may be more strongly related to avoidance of disapproval and an avoidant problem-solving style. Although no research has directly compared the influence of FF vs. DT with regard to smoking behavior, FF and DT might represent distinct motivations for smoking. We predicted that both FF and DT would be significantly associated with cigarette smoking, but that FF would be a stronger predictor of smoking behavior, even after controlling for variables such as body mass index (BMI) and nicotine dependence. Participants (N=289) were female college undergraduate students. Daily smokers had the highest scores on measures of DT and FF, followed sequentially by infrequent smokers, "triers," and never smokers. More frequent smokers also reported greater levels of body dissatisfaction and eating pathology than less frequent and never-smokers. Hierarchical regression analyses showed that greater DT predicted higher likelihood of smoking on a daily basis; however, higher FF predicted fewer cigarettes smoked per day. FF and DT may each play a role in the relationship between eating pathology and smoking, but they might be differentially related to specific smoking patterns. Both FF and DT and their coinciding coping styles should be further researched in the role of smoking initiation and maintenance.

"Glass fairies" and "bone children": adolescents and young adults with anorexia nervosa show positive reactions towards extremely emaciated body pictures measured by the startle reflex paradigm

In this study, we investigated the emotional processing of extremely emaciated body cues in adolescents and young adults with (n  =  36) and without (n =  36) anorexia nervosa (AN), introducing a new picture type, which was taken from websites that promote extreme thinness and is targeted specifically at adolescents interested in extreme thinness. A startle reflex paradigm was used for implicit reactions, while a self-assessment instrument was used for subjective responses. We found a significant group difference with a startle inhibition (appetitive response) among the patients and a startle potentiation (aversive response) among the controls, whereas no such difference for subjective measures was found. The results are in contrast to previous studies, which proposed a general failure to activate the appetitive motivational system in AN, but in keeping with findings from other addictions, where the same response pattern has been found. Implications for prevention and therapy are discussed.

Wanting a body that's better than average: the effect of manipulated body norms on ideal body size perception

We examined the effect of body norms on ideal and current body size perception. In Study One, female participants were randomly assigned to one of three experimental conditions: (1) a thinner body norm, (2) a heavier body norm, or (3) no body norm. Body norms were manipulated by indicating a bogus "population average," and current and ideal body size perception were subsequently measured using a body silhouettes measure. Women had a thinner ideal body size in the thinner norm condition than in the heavier norm condition. Study Two replicated these results, but in a sample of young men and with regards to muscularity rather than thinness. Men had a more muscular ideal body size in the more muscular norm condition than in the less muscular norm condition. Current body size perception was also influenced by body norms, but only for women and after controlling for BMI.

An Interactionist Model of Self-Concept and Eating Habits

Our aim was to determine whether a negative self-concept and unhealthy eating habits of adolescents could improve after being exposed to a psycho-educational programme involving cognitive-behaviour therapy and hypnotherapy. A qualitative investigation was done with nine adolescents ranging between 12 and 18 years of age. An initial situation analysis was done to identify adolescents with unhealthy eating habits and problematic self-concepts. Support was given in a number of individual and group therapy sessions, focusing on eating habits, cognitive distortions and self-concept. From the evaluation of the outcome of the intervention, it appears that the proposed Interactionist Model of Self-concept and Eating Habits can be used as an effective therapeutic instrument in a psycho-educational intervention programme when working with adolescents with unhealthy eating habits and problematic self-concepts.

Treating eating disorder patients who have had traumatic experiences: a self-regulatory approach

Eating disorder (ED) patients are presenting with increasingly complex symptom pictures consisting of layers of potential interaction between their eating disorder, impact of their traumatic experiences, and their social environment. Consequently, clinicians are challenged to utilize approaches that efficiently and effectively organize treatment for this particular population. This paper describes an therapeutic organizational model, based on self-regulation theory, that clinically has been found to be useful and effective for working with complex, multi-symptomatic ED patients.