Comparative effects of Facebook and conventional media on body image dissatisfaction

Higher orthorexia tendency among female fashion models: an empirical international study

PURPOSE

Female fashion models are more at risk for developing eating disorders than non-models due to the intense occupational pressure they face. The present study focuses on assessing whether female models are more prone to report orthorexia nervosa signs and symptoms than non-models.

METHODS

Female fashion models (n = 179, mean age: 25.9 SD = 4.40 years) and an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years) were selected by snowball sampling. Participants filled out an online survey containing anthropometric questions and the 18-item Eating Habits Questionnaire.

RESULTS

According to BMI, fashion models were underweight (mean BMI = 18.1 SD = 1.68) while control participants' BMI was in the normal range (mean = 22.1 SD = 4.23, p < 0.001). On all three of Eating Habits Questionnaire subscales fashion models showed significantly higher average value (Knowledge subscale: M = 2.42 among models versus M = 2.08 in the control group, p < 0.01, Cohen's d = 0.52; Problems subscale: M = 1.93 among models versus M = 2.61 in the control group, p < 0.01, Cohen's d = 0.49; Feelings subscale: M = 3.20 among models versus M = 2.96 in the control group, p < 0.01, Cohen's d = 0.38). Orthorexic tendencies were reported by 35.1% of the models versus 20.2% of controls.

CONCLUSION

Fashion models are at risk for the development of eating disorders. Even though not yet included in the DSM-5, the assessment of orthorexia nervosa among fashion models seems to be important. It is suggested to take appropriate measures to prevent the spread of disordered eating habits among models as they can lead to the development of anorexia nervosa or bulimia nervosa.

LEVEL OF EVIDENCE

Level III, well-designed cohort study.

Smartphone use and its association with body image distortion and weight loss behaviours among adolescents in Saudi Arabia

BACKGROUND

Concerns about the harmful effects of smartphone use on teenage development have been raised as the use of cell phones among adolescents has risen.

OBJECTIVE

This study aimed to examine the associations of smartphone usage patterns with Body Image Distortion (BID) and weight loss behaviors among adolescent smartphone users in Saudi Arabia.

METHODS

This population-based, cross-sectional study was conducted from July to October 2022. We assessed the mean daily length of smartphone use and classified it into quartiles using data from a self-reported survey and data on weekday and weekend use. Self-reported body weight and height were collected via an online survey. Out of the 11384 adolescents, the majority was females (65.7%) and was secondary school students (68.9%).

RESULTS

The prolonged smartphone use (301 min/d) was found in 36.4% of adolescents, 181-300 min/d in 27.6% of respondents, 121-180 min/d in 22.4% of respondents, while the modest smartphone use (1-120 min/d) was found only in 13.6% of participants. The duration of smartphone use was significantly associated with BID (P= 0.000); students with middle perceived stress levels (51.4%) and no depressive symptoms (68.9%) used smartphones 121-180 min/d sparingly. However, prolonged smartphone use was significantly associated with the presence of depressive symptoms (42.6%) and high perceived stress levels (21.5%). Weight loss behaviors were significantly associated with smartphone use duration. Modest smartphone use was significantly found in students with normal weight (P= 0.00, 71.9%); however, aerobic physical activity weight loss strategy (P= 0.00, 30.9%) was correlated with prolonged smartphone use.

CONCLUSION

Adequate parental advice is required to assist teenagers in developing healthy smartphone usage practices. Digital platform companies may increase their social responsibility for the information generated and delivered on their networks, boosting its beneficial effect.

Influence of social media and corrected smile photographs in patients with malocclusion

INTRODUCTION

The increased use of social networking sites, such as Instagram (Meta Platforms, Menlo Park, Calif), has been silently affecting facial satisfaction among patients. However, the potential of Instagram to motivate participants for orthodontic treatment when used with an adjunct, a photograph editing software, is yet to be assessed.

METHODS

From the initial 300 participants, 256 were included and randomly divided into an experimental group (participants were asked to provide their frontal smiling photograph) and a control group. The photographs received were corrected using photograph editing software and were shown along with other ideal smile photographs in an Instagram account to the experimental group, whereas the control group participants had access to only the ideal smile photographs. After browsing, the participants were given a modified version of the Malocclusion-Related Quality of Life Questionnaire.

RESULTS

Questions assessing the general perception about one's smile, comparison with peers, desire to undergo orthodontic treatment, and the role of socioeconomic status showed a statistically significant difference (P <0.05) as most of the control group participants were unsatisfied with their teeth, had less desire to undergo orthodontic treatment and did not feel family's financial income to be a hurdle, contrary to the experimental group participants. A statistically significant difference (P <0.05) was also seen in assessing external acceptance, speech difficulties, and the influence of Instagram on orthodontic treatment, whereas the influence of photograph editing software did not show the same.

CONCLUSIONS

The study concluded that the experimental group participants were motivated to undergo orthodontic treatment after viewing their corrected photograph.

Systematic review of social media addiction among health workers during the pandemic Covid-19

The risk of social media (SM) addiction exponentially increases when social media is utilized during office hours for health workers. This study aims to explore the various factors that influence SM addiction in healthcare workers and to identify the potential social media addiction associated with it. The design used in this research is a systematic review with text mining methods and PRISMA (Preferred Reporting Items for Systematic Reviews & Meta-Analyses). The databases used in this study are PubMed, ProQuest, science direct, Elsevier, and Sage journals for data collection. The used keywords were associated factors, influencing factors, social media, addiction, healthcare workers, outbreak, pandemic, and COVID-19. The inclusion criteria were quantitative research, international studies, published in 2020-2022, published in Q1-Q3 journals, and open access studies and the exclusion criteria were not systematic review studies. Publications without English language and abstracts only also will be excluded. Advanced search is selected by using topics with strings "associated factors", and "influencing factors" and strings "outbreak", "pandemic", and "COVID-19". Furthermore, data extraction is carried out using text mining by the R programming to present the characteristics of publications and identify the descriptive result, such as term quantity, term replication, and Hierarchical cluster analysis. Descriptive analysis is used to present the percentage and frequency of data characteristics. Text mining begins with data preparation, namely importing text and string operations. The dataset and tokenization are created after importing the text. The most answered terms extracted from the analysis were combined into terms that will be the focus of a further investigation. A considerable part of healthcare professionals experienced Internet addiction, according to a study on the incidence and risk factors of Internet addiction among healthcare workers. Mental health not only affects physical health but also has effects on social and professional functioning in addition to being connected to personal health. Among health professionals, higher Internet and social media use was substantially linked to both anxiety and depression, as well as overall psychological health and increased substance use.

The Correlation between Social Media Addiction and Emotional Eating during the COVID-19 Quarantine Period

This study was conducted with 458 participants. The demographic and health information of the participants along with the Social Media Addiction, Emotional Eating Scale were obtained. The level of social media addiction in adults was moderate, and women were more interested in social media than men. As the average age of participants increased, the virtual tolerance, virtual communication, social media scores decreased (p < .05). The study found that 51.6% of individuals with emotional eating tendencies happened to be obese. The social media addiction scale scores of those with emotional eating tendencies were higher than those without emotional eating tendencies (p < .05).

Body norms, body image, and media in a market-integrating indigenous population in Argentina: A mixed-methods investigation

OBJECTIVE

The aim of this study was to investigate the relationship between media, body norms, and body image among the Qom, a market-integrating indigenous population in Argentina that has historically idealized larger body sizes.

METHODS

With men and women (n = 87), we measured frequency of media/technology use through a Likert-type questionnaire. Using the Stunkard Figure Rating Scale, we asked participants to select the most healthy and ideal body size for their gender, as well as their own body size. We calculated body dissatisfaction as the difference between ideal and own body size. We conducted semi-structured interviews to describe the role of media in body norms and body image.

RESULTS

Media exposure was not significantly associated with perceptions of the "healthiest" or most "ideal" body sizes, nor body dissatisfaction. Men and women perceived categorically "middle-range" body sizes as both healthy and ideal, differing from a similar study in 2010, where larger bodies were favored. Interviews revealed that: media is not recognized as affecting body norms and body image, but is conceptually associated with cultural loss (Theme 1); a "dual stigma" of fatness and thinness is perpetuated by peers, family, and healthcare providers (Theme 2); and body acceptance is highly valued (Theme 3).

CONCLUSION

In this context, while some body norms have changed over time, the impact of media on body norms and image may be secondary to influences from individuals' social networks, and may be occluded by norms favoring body acceptance.

Association between physical activity and online sexual objectification experience: The mediating role of body-image depression

Objective

With the popularization and development of online media technology, more and more women are paying attention to their body image and physical behavior. The purpose of this study was to investigate the effect of online sexual objectification experience on the physical activity of female college students and verify the mediating role of body-image depression between them.

Methods

A cross-sectional convenient sample of 882 female college students from four universities in Hubei Province completed an online survey, and the Online Sexual Objectification Experience Scale (OSOES), the Body-Image Depression Questionnaire, and the Physical Activity Rating Scale (PARS) were used to collect the data. The mediating effect of the association between online sexual objectification experience and physical activity, was examined using the process procedure in SPSS and the bootstrap method.

Results

Online sexual objectification experience was significantly positively correlated with physical activity (r = 0.420, p < 0.01). Body-image depression was significantly negatively correlated with online sexual objectification experience and physical activity (r = -0.484, p < 0.01; r = -0.569, p < 0.01). Online sexual objectification experience can affect physical activity directly (β = 6.49, p < 0.001, effect value 44.97%) and also indirectly through body-image depression (β = 7.95, p < 0.001, effect value 55.03%); there were significant differences between major and education-level categories in body-image depression and physical activity.

Conclusion

Both online sexual objectification experience and body-image depression can promote physical activity among female college students, and body-image depression has a mediating effect between online sexual objectification experience and physical activity.

#fitspiration: a comparison of the sport-related social media usage and its impact on body image in young adults

BACKGROUND

Following and posting sport-related content on social media is wide-spread among young people. To date, little is known about the interdependence between sport-related social media use and the thereby perceived personal body image.

METHODS

We conducted an online survey (N = 285) to examine how social media influences the sport-related body image.

RESULTS

In general, social media are frequently used for sport (n = 136, 47.7%). Resistance training correlated significantly with several motives of sport-related use of social media, and thus, represents the strong online presence of athletic sports. Less correlations could be found in team or other sports. Regarding the perception of body image, it was found that the group of rejecting (negative) body image significantly correlated with the emulation of social media mediated sport-related beauty and body ideals (r = 0.63, p = 0.001), as well as with increased body dissatisfaction when viewing sport-related posts on social media (r = 0.590, p = 0.001). Perceived social pressure and comparison were found to be mediators of the prevailing influence of social media usage.

CONCLUSIONS

These results reveal the importance of taking a closer look at socially shaped beauty and body ideals, especially in sport-related contents, striving for more educational campaigns such as Body Positivity and, above all, filtering information. Finally, future research is needed to gain deeper insight into young persons' usage behavior of social media and its impact on the individual's body image. Trial Registration The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of University of the Federal Armed Forces Munich, Germany (01/24/2022).

The association between social media addiction and orthorexia nervosa, eating attitudes, and body image among adolescents

AIM

This study was planned to determine the relationship between social media addiction and orthorexia nervosa (ON), eating attitude and body image among adolescents.

METHOD

This cross-sectional study was conducted with 1232 high school-going adolescents. Data were collected using the Social Media Addiction Scale for Adolescents, Eating Attitude Test-26 (EAT-26), Body Image Scale (BIS) and ORTO-11 questionnaire.

RESULTS

Social media addiction levels were higher in girls than in boys (p < 0.05). Multiple linear regression analysis showed that a better body image was associated with lower social media addiction scores (β =  - 0.268, p < 0.001). Social media addiction was significantly associated with a greater risk of eating behavior disorders (OR: 1.07, 95% Cl: 1.04-1.10) and ON tendency (OR: 1.02, 95% Cl = 1.00-1.04). Adolescents who stated that they always or often read nutrition-related posts on social media had an increased likelihood of eating behavior disorder risk (OR: 6.77, 95% CI: 3.84-11.94) and ON tendency (OR: 5.49, 95% CI: 3.39-8.88).

CONCLUSION

This study demonstrated that social media addiction was associated with a higher eating behavior disorder risk, ON tendency and lower body image. Moreover, frequent reading of posts about nutrition on social media was positively associated with ON tendency and eating behavior risk. These results highlight that adolescents should be educated about social media use and its content to minimize the negative effects of constant exposure to unrealistic body images and nutrition-related misinformation and reduce the risk of eating disorders and ON among adolescents. Level of evidence Level V, cross-sectional descriptive study.

Broad conceptualisations of beauty do not moderate women's responses to body positive content on instagram

Body positive content on Instagram may act as an antidote to the frequent depictions of thin and digitally modified images of women. Body positivity challenges narrow ideals by promoting diverse appearances and encouraging body appreciation. We examined the effects of congruent body positive messaging (unedited images of a diverse range of women presented with and without body acceptance captions) on state body image. This was the first study to investigate the moderating role of trait broad conceptualisation of beauty; a core component of body positive content and theories. Women 18-30 years (N = 233) were randomly assigned to view Instagram images of diverse women (e.g., varied body sizes, shapes, skin colour), either presented with or without body positive captions, or cityscape images. Pre- and post-test measures were taken of state body appreciation, appearance satisfaction, and positive mood, in addition to social comparison measures. Body appreciation and positive mood increased in all conditions. Appearance satisfaction only increased in the body positive conditions, with a larger effect size in the caption condition. Holding broad conceptualisations of beauty did not moderate findings. Captions did not change direction or amount of social comparison. Findings suggest that congruent body positive content may increase appearance satisfaction in viewers.

Breasts, Butts, and Thighs—Oh My! Weight Spurt and Body Image Messages in Girls’ Puberty Books

Analyze popular girls’ puberty books to understand what messages they portray about weight spurt and body image. A critical ethnography was conducted of 13 best-selling books about girls’ puberty. This analysis specifically focused on messages about weight gain/spurt and body image presented in the books and whether these were aligned with larger cultural understandings of weight gain and body image. A data-driven thematic analysis was conducted on the portions of each book relevant to weight gain and body image. The cultural fat-phobic scripts were prevalent in the books, contrasting the well-intended developmental messages. Discussions of weight tended to be negatively framed and weight gain expectations were distressingly vague. The books discussed the necessity of and biological rationale for those changes while normalizing variation in timing. The books also focused on developing a positive body image during this time. Understanding this allows us to see the pervasive, conflicting messages about weight-spurts that girls are receiving from these resources, which can be used to tailor book choice and outreach programs.

The Associations Between the Anorexic Readiness Syndrome, Familism, and Body Image Among Physically Active Girls

Introduction: Anorexic Readiness Syndrome (ARS) is a construct of prophylactic importance, useful in the selection of people showing a tendency to use restrictive diets and increased concentration on the body. The aim of the research was to verify the significance of the type of physical activity, body perception and familism for the development of ARS. Material and Method: The research was carried out in the first half of 2021on a sample of 163 girls. It consisted of: (1) physically inactive girls (n = 48), (2) physically active girls in disciplines other than aesthetic (n = 69), (3) girls engaged in aesthetic physical activity (n = 46). The study used: Anorexic Readiness Syndrome Questionnaire (ARS-12), Familism Scale (FS) and Body Image Avoidance Questionnaire (BIAQ). Results: The highest average ARS score was recorded in the group of girls engaged in aesthetic activity. A significant difference in the severity of ARS occurs between people who do not engage in activity and those who practice aesthetic activity. The severity of ARS rises as the difference between real and ideal body weight increases. People active in aesthetic disciplines who obtained a high score on the Respect scale (FS subscale) have a lower ARS score than those physically active in other disciplines who obtained low scores on the Respect scale. The higher the score on the Material success and achievement scale (FS), the greater the ARS intensity in all subgroups. What is much more important in shaping ARS is the perception of your body. The focus on eating and body weight and Clothing and appearance (BIAQ subscales) are relevant to the ARS and moderate the relationship between Material success (FS subscale) and anorexic readiness. Conclusions: People engaging in aesthetic physical activity are more likely to suffer from ARS. The family can certainly prevent a child from developing anorexic readiness by shaping a sense of community and family identity, a clear division of roles, limiting the importance of materialism and competition in raising children. The prevention of ARS and eating disorders should also focus on strengthening the realistic assessment of body parameters and their acceptance, as well as promoting strategies for healthy weight control.

Photo manipulation as a predictor of facial dissatisfaction and cosmetic procedure attitudes

Photo manipulation (editing photos prior to sharing them) has become increasingly popular on social media. While intended to enhance a photo's quality, this behaviour has been linked to heightened body image concerns. The present study investigated whether social media photo manipulation predicts facial dissatisfaction, attitudes towards cosmetic procedures, and intentions to undergo facial cosmetic procedures in young women, and the moderating role of self-discrepancy therein. Australian women (N = 227, 17-25 years) completed an online cross-sectional questionnaire. Social media photo manipulation was associated with greater facial dissatisfaction, cosmetic procedure attitudes/intentions, and appearance-based self-discrepancy. Photo manipulation was a significant predictor of cosmetic procedure attitudes and intentions, but not of facial dissatisfaction. Appearance-based self-discrepancy significantly moderated the relationship between photo manipulation and facial dissatisfaction, whereby the relationship between photo manipulation and facial dissatisfaction was stronger for those with lower self-discrepancy. Results highlight a key role for photo manipulation and appearance-based self-discrepancies in relation to facial dissatisfaction for young women. They also provide insight into predictors of cosmetic procedure intentions and attitudes. This signals a pressing need to develop effective intervention and prevention programs to help young women limit their appearance-based photo manipulation behaviours for use on social media.

Social media, body image, and the question of causation: Meta-analyses of experimental and longitudinal evidence

This article presents four meta-analyses that can inform causality in the relationship between social media and body image; 24 experimental samples comparing the effect of appearance-ideal social media images to non-appearance-related conditions (n = 3816); 21 experimental samples examining the effect of contextual features (e.g., comments and captions) accompanying appearance-ideal social media images (n = 3482); 14 experimental samples investigating the effect of appearance-ideal images versus other appearance images on social media (n = 2641); and 10 longitudinal samples on social media use and body image (n = 5177). Social media appearance-ideal images had a moderate negative effect on body image (Hedges' g = -0.61, p < .01), were more damaging in higher- than lower-risk contexts (Hedges' g = -0.12, p < .01), and were moderately more impactful than other social media appearance images (Hedges' g = -0.68, p = .05). These effects were smaller but significant with outliers removed. Social media use had a very small, negative correlation with body image longitudinally (Fisher's Z = -0.08, p < .001). No significant moderators emerged. Clinicians should consider approaches to managing social media use, particularly exposure to appearance-ideal imagery, in case conceptualisation and psychoeducation for clients at risk of, or experiencing, body image disturbance.

Orthorexia tendency and social media addiction among candidate doctors and nurses

PURPOSE

To determine orthorexia tendency and social media addiction among candidate doctors and nurses.

DESIGN AND METHODS

This was a cross-sectional study conducted in 2019 with 969 candidate doctors and nurses training in a peripheral public university. Data were collected via ORTO-15 and Social Media addiction scales and analyzed by using percentage, mean, χ ² test, and binary logistic regression.

FINDINGS

Of the study population, 78.8% were social media addicts and 62.2% had orthorexic tendencies. The ratio of orthorexic tendency was 31.0% among high/very high addicts (p < 0.05).

PRACTICE IMPLICATIONS

In preclinical years, both groups should be screened for early detection of orthorexia tendency and social media addiction. A combination of therapy and nutrition education should be used and social media literacy should be promoted to raise awareness of orthorexia.

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

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

Tanning Misinformation Posted by Businesses on Social Media and Related Perceptions of Adolescent and Young Adult White Non-Hispanic Women: Mixed Methods Study

BACKGROUND

Indoor ultraviolet (UV) tanning is common and consequential, increasing the risk for cancers including melanoma and basal cell carcinoma. At-risk groups include adolescents and young adults, who often report beliefs about benefits of tanning. Adolescent and young adults are also among the most ubiquitous social media users. As previous studies support that content about tanning is common on social media, this may be a way that young women are exposed to influential content promoting tanning, including health misinformation.

OBJECTIVE

The purpose of this study was to evaluate health misinformation promoted by indoor tanning businesses via social media and to understand young women's perceptions of this misinformation.

METHODS

This mixed methods study included (1) retrospective observational content analysis of indoor tanning salons' content on Facebook over 1 year and (2) qualitative interviews with a purposeful national sample of 46 White non-Hispanic women, age 16 to 23 years, who had recently tanned indoors. We assessed experiences with tanning businesses' posted content on social media through interviews. We used the constant comparative approach for qualitative analyses.

RESULTS

Content analysis findings included data from indoor tanning businesses (n=147) across 50 states, yielding 4956 total posts. Among 9 health misinformation topics identified, the most common was the promotion of UV tanning as a safe way to get Vitamin D (n=73, 1.5%). An example post was "Stop by Body and Sol to get your daily dose of Vitamin D." Another misinformation topic was promoting tanning for health benefits (n=31, 0.62%), an example post was "the flu is not a season, it's an inability to adapt due to decreased sun exposure…" A total of 46 participants completed interviews (age: mean 20 years, SD 2). Almost all participants (45/46, 98%) used Facebook, and 43.5% (20/46) followed an indoor tanning business on social media. Approximately half of participants reported seeing social media posts from tanning salons about Vitamin D, an example of a participant comment was "I have [seen that] a few times..." Among the participants, approximately half believed it was safe to get Vitamin D from indoor UV tanning; a participant stated: "I think it is a valid benefit to UV tanning."

CONCLUSIONS

Despite the low frequency (range 0.5%-1.5%) of social media posts promoting health misinformation, participants commonly reported viewing these posts, and their perceptions aligned with health misinformation. Health education campaigns, possibly using social media to target at-risk populations, may be an innovative approach for tanning prevention messages.

Problematic usage of the internet and eating disorder and related psychopathology: A multifaceted, systematic review and meta-analysis

Eating disorders are widespread illnesses with significant impact. There is growing concern about how those at risk of eating disorders overuse online resources to their detriment. We conducted a pre-registered systematic review and meta-analysis of studies examining Problematic Usage of the Internet (PUI) and eating disorder and related psychopathology. The meta-analysis comprised n = 32,295 participants, in which PUI was correlated with significant eating disorder general psychopathology Pearson r = 0.22 (s.e. = 0.04, p < 0.001), body dissatisfaction r = 0.16 (s.e. = 0.02, p < 0.001), drive-for-thinness r = 0.16 (s.e. = 0.04, p < 0.001) and dietary restraint r = 0.18 (s.e. = 0.03). Effects were not moderated by gender, PUI facet or study quality. Results are in support of PUI impacting on eating disorder symptoms; males may be equally vulnerable to these potential effects. Prospective and experimental studies in the field suggest that small but significant effects exist and may have accumulative influence over time and across all age groups. Those findings are important to expand our understanding of PUI as a multifaceted concept and its impact on multiple levels of ascertainment of eating disorder and related psychopathology.

Weight stigma and media: An examination of the effect of advertising campaigns on weight bias, internalized weight bias, self-esteem, body image, and affect

While some media perpetuate weight stigma and an ideal of thinness, certain advertising campaigns, such as Aerie Real and Dove Real Beauty, have attempted to promote body acceptance. The current study evaluated the influence of exposure to these campaigns on weight bias, internalized weight bias (IWB), self-esteem, body image, and affect relative to exposure to a campaign perpetuating the thin ideal and a documentary on weight stigma. 475 female participants were randomized to one of five conditions: Aerie, Dove, Victoria's Secret, an HBO documentary, or control (i.e., neutral video clip). Participants completed measures of weight bias, IWB, self-esteem, body image, and affect one week prior to and immediately after watching the assigned video clip. Results showed positive effects of the Aerie and Dove campaigns on women. While global measures of weight bias and IWB were unchanged, women who viewed the Dove and Aerie campaigns reported significantly improved self-esteem and positive affect. Further, women found the campaigns to have positive, uplifting, and empowering messages. Aerie's and Dove's acceptance-promoting advertising campaigns positively influenced self-esteem and mood, and they are potential tools for weight bias reduction. Advertisements and media have the potential to impact weight-based attitudes in society.

Celebrity influence on body image and eating disorders: A review

Celebrities are well-known individuals who receive extensive public and media attention. There is an increasing body of research on the effect of celebrities on body dissatisfaction and disordered eating. Yet, there has been no synthesis of the research findings. A systematic search for research articles on celebrities and body image or eating disorders resulted in 36 studies meeting inclusion criteria. Overall, the qualitative, correlational, big data, and experimental methodologies used in these studies demonstrated that exposure to celebrity images, appearance comparison, and celebrity worship are associated with maladaptive consequences for individuals' body image.

The Relationships among Self-Worth Contingency on Others' Approval, Appearance Comparisons on Facebook, and Adolescent Girls' Body Esteem: A Cross-Cultural Study

The present study examined the relationship between appearance-related social comparison on social networking services (SNSs) and body esteem in a cross-cultural context (three European countries, i.e., Austria, Belgium, and Spain, versus one Asian country, i.e., South Korea). The role of self-worth contingency on others' approval was considered to be a psychological and cultural factor. Utilizing a large-scale cross-national survey of early and middle adolescents in 2017, the responses of female adolescents (N = 981) were analyzed. The results generally support the findings from previous studies but also reveal cultural differences. Appearance comparison on Facebook negatively influenced girls' body esteem in all European countries, but not in South Korea. Self-worth contingency on others' approval negatively influenced girls' body esteem across all four countries. Finally, a positive relationship between self-worth contingency on others' approval and appearance comparison on Facebook was found in all European countries, but not among Korean girls. These findings suggest the importance of self-worth contingency on others' approval and cultural contexts can be used to study the effects of body image-related SNS use.

The Relationship between Body Appreciation and Self-Esteem and Associated Factors among Omani University Students: An Online Cross-Sectional Survey

BACKGROUND

Given the rapid pace of globalization and the fact that the Sultanate of Oman is experiencing a significant impact of social media on specifying appearance norms among youth in the country, research into positive body images and self-esteem among young individuals has become a national priority. Whilst body image has been well studied across cultures, both positive body image and the relationship between positive body image and self-esteem among Omani youth have been neglected. The aim of the study was to investigate the relationship between positive body image and self-esteem and associated sociodemographic factors among Omani university students based on gender.

METHODS

This cross-sectional study used an online survey consisting of the two questionnaires that are Body Appreciation Scale-2 and Rosenberg's Self-Esteem Scale. A total of 237 students were recruited from Sultan Qaboos University's different colleges.

RESULTS

The results indicated that positive body image has a significant relationship with an individual's self-esteem (β = 0.122, t = 2.197, p=0.038), Cumulative Grade Point Average (cGPA) (β = 0.140, t = 2.306, p=0.022), body mass index (BMI) (β = -0.414, t = -6.930, p < 0.001), monthly household income (β = -0.129, t = 2.467, p=0.029), and the number of social media accounts (≥2, β = -0.132, t = -2.232, p=0.027). In addition, an individual's self-esteem was significantly associated with an individual's cGPA (β = 0.231, t = 3.592, p < 0.001) and mothers' educational level (β = -0.130, t = -2.065, p=0.040) besides body appreciation (β = 0.160, t = 2.491, p=0.013).

CONCLUSIONS

The findings of this study shed light on the current status of positive body image among university students of Oman. In light of the new knowledge, we propose health interventions that include strategies such as involvement of family, to maintain and/or promote positive body image perceptions among young individuals and subsequently promote healthy appreciation of the physical appearance and self-esteem.

Building resilience to body image triggers using brief cognitive training on a mobile application: A randomized controlled trial

OBJECTIVE

Body image disturbance (BID) is common among women, characterized by persistent and distressing appearance dissatisfaction, and linked with eating disorders. Although effective, cognitive behavioral therapy (CBT) delivered by trained professionals is not easily accessible. This randomized trial evaluated the effects of a CBT-based mobile application designed to increase resilience to body image triggers and reduce BID symptoms.

METHOD

A non-clinical sample of women (N = 90; M_age = 23.52) was randomized to use the mobile application for approximately 4 min of daily exercises for two weeks or to a control condition. Body image was measured at baseline, immediately after two weeks of mobile application use, and at 1-month follow-up. To examine whether using the application was associated with increased resilience to common BID triggers, participants completed an Instagram exposure resilience task upon completion and at 1-month follow-up.

RESULTS

Relative to those in the control condition, participants who used the application demonstrated increased resiliency and reduced BID symptoms. Theses effects were medium-to-large and were maintained at 1-month follow-up.

CONCLUSION

These results underscore the potential usefulness of brief, low-intensity, portable interventions in reducing BID symptoms and in increasing resilience to thin-ideal body messages often portrayed on social media.

Treating Eating: A Dynamical Systems Model of Eating Disorders

Mainstream forms of psychiatric talk therapy and cognitive behavioral therapy (CBT) do not reliably generate lasting recovery for eating disorders. We discuss widespread assumptions regarding the nature of eating disorders as fundamentally psychological disorders and highlight the problems that underlie these notions, as well as related practical problems in the implementation of mainstream treatments. We then offer a theoretical and practical alternative: a dynamical systems model of eating disorders in which behavioral interventions are foregrounded as powerful mediators between psychological and physical states. We go on to present empirical evidence for behavioral modification specifically of eating speed in the treatment of eating disorders, and a hypothesis accounting for the etiology and progression, as well as the effective treatment, of the full spectrum of eating problems. A dynamical systems approach mandates that in any dietary and lifestyle change as profound as recovery from an eating disorder, acknowledgment must be made of the full range of pragmatic (psychological, cultural, social, etc.) factors involved. However, normalizing eating speed may be necessary if not sufficient for the development of a reliable treatment for the full spectrum of eating disorders, in its role as a mediator in the complex feedback loops that connect the biology and the psychology with the behaviors of eating.

Posting edited photos of the self: Increasing eating disorder risk or harmless behavior?

OBJECTIVE

Social media use has been implicated as a correlate and a cause of increased disordered eating (DE), but little is known about the impact of specific aspects of social media use, such as posting edited photos of the self. Utilizing a two-stage design, the present study sought to determine how posting edited photos relates to DE, as well as anxiety and depression symptoms, in male and female college students.

METHOD

Stage 1 examined concurrent associations between posting edited photos and mental health measures in 2,485 undergraduates (76% female). Stage 2 examined causal associations between posting edited photos and eating disorder (ED) risk factors in 80 undergraduates (93% female) who endorsed posting edited photos in Stage 1 and volunteered for the experimental portion of the study.

RESULTS

In Stage 1, those who endorsed posting edited photos (n = 660; 27%) reported greater eating pathology and anxiety than those who did not, but no differences were found for depressive symptoms. In Stage 2, posting edited photos caused increased weight/shape concerns. Posting photos reinforced urges to exercise and restrict food intake and anxiety. Editing photos without posting caused an immediate decrease in weight/shape concerns and a delayed decrease in sadness.

DISCUSSION

Results support a consistent and direct link between posting edited photos and ED risk factors, suggesting that this is not a harmless behavior. Future work should explore the cumulative effects of this link to determine how specific uses of social media contribute to clinically meaningful outcomes.

Looking down on Others to Feel Good about the Self: The Exposure Effects of Online Model Pictures on Men's Self-Esteem

This study examined how exposure to online pictures of male models with different body sizes (thin, overweight) and physical attractiveness levels (attractive, unattractive) affected men's self-esteem (appearance- and weight-related self-esteem). Men exposed to attractive model pictures showed lower appearance-related self-esteem compared with those exposed to unattractive models. Among participants who were exposed to overweight models, those who were exposed to attractive models showed lower appearance- and weight-related self-esteem compared with those exposed to unattractive models. Men who saw themselves as more attractive or thinner than the models showed higher appearance- or weight-related self-esteem. The results imply a downward social comparison effect in which men reported higher self-esteem when exposed to model pictures they found less attractive or heavier compared with themselves.

Predictors of One-Year Change in How Youth Perceive Their Weight

Overall, perceptions of being at "about the right weight" appear advantageous for youth physical and mental health, regardless of BMI classification, whereas perceptions at either extreme (overweight or underweight) may negatively impact health behaviours and mental health. Instead of considering weight misperceptions as problematic, some researchers have proposed that underestimations of weight status may offer resiliency among individuals with overweight or obesity. Promoting "about right" WPs and preventing change to overweight or underweight perceptions may offer an effective public health strategy for supporting youth health over time. However, limited prospective evidence exists on factors that shape perceptions of weight status over time. The current study examined modifiable predictors of one-year change in weight perception among youths. We used 2-year linked data of 18,112 grade 9-12 students from Year 3 (Y₃:2014-2015) and Year 4 (Y₄:2015-2016) of the COMPASS study. Generalized Estimating Equation models tested screen use, physical activity, and bullying victimization as predictors of change from perceptions of "about the right weight" to "overweight" or "underweight" perceptions, adjusting for Y₃ covariates (body mass index, ethnicity, and grade) and school cluster. Results support the value of team sports among females and resistance exercise among males as protective against changes to overweight or underweight perceptions over one year. Also, various forms of bullying victimization predicted overweight perceptions in males and females. Watching TV/movies or messaging/texting for over 2 hours/day was associated with overweight and underweight perceptions, respectively, in females only. Playing video/computer games for over 2 hours/day was associated with overweight perceptions in males and underweight perceptions in females. Findings support the potential of bullying prevention, limiting certain screen use, and supporting engagement in team sports for females and resistance exercise for males as strategies to maintain perceptions of being at "about the right weight."

Socio-Cultural Standards Promoted by the Mass Media as Predictors of Restrictive and Bulimic Behavior

Research lacks in verifying the nature of the relationship between mass media pressure, body image, and the risk of unhealthy eating behaviors. This study aimed to investigate whether the internalization of sociocultural norms, perceived pressure or searching for information about body image promoted by the mass media directly affect restrictive and bulimic behavior toward eating, through the mediating role of body image and physical appearance variables. The research hypotheses were that (1, 2) body image, the pressure and the internalization of sociocultural norms are significant predictors of unhealthy eating behavior among women and men; and (3) the variables related to body image play the role of the mediating variable between the impact of socio-cultural standards of body image promoted by the mass media and unhealthy eating behavior. The sample comprised 514 Polish men and women, aged 16 to 63 old (men M=24.35; SD=13.53; women M=24.77; SD=7.61), with average Body Mass Index (BMI). Assessment comprised the Sociocultural Attitudes Toward Appearance Scale (SATAQ-3), Eating Disorders Inventory (EDI 3), The Multidimensional Body-Self Relations Questionnaire (MBSRQ-AS), and the author's survey questionnaire. The descriptive and comparative statistics, and a path analysis (structural equations modeling) were applied. The statistical analysis showed that the variables related to body image do not play the role of intermediary variables. The pressure of sociocultural standards of body image and physical appearance had the strongest and most direct effect on the development of restrictive eating behavior and appeared to negatively affect body image in women. The search of information on body image in the mass media had the strongest and most direct impact on the development of bulimic eating behavior among women. However, only the global internalization of sociocultural standards of body image and physical appearance had a significant and direct effect on the development of bulimic eating behavior in men. Moreover, the internalization of athletic body shape standards had the strongest and most positive impact on some aspects of body image in this group. No sociocultural variables showed a direct impact on restrictive behavior among studied men. BMI had a positive and direct impact on individual body part satisfaction. These results may help improve prevention of eating disorders and dysfunctional eating behavior.

Disordered eating behaviours, body image and social networking in a type 1 diabetes population

The purpose of this study was twofold: to examine predictors of disordered eating behaviours and body image dissatisfaction, including social networking, among type 1 diabetes population, and to qualitatively explore the relationship between type 1 diabetes management and body image. A convenience sample of 121 type 1 diabetes patients (F = 106; M_age = 36 ± 6.5) was collected via online questionnaires, of which 98 patients responded to two open-ended questions. Young age and negative body image explained 58.8 per cent of disordered eating variance, while body weight and social networking negatively contributed to poor body image (29.9%). Qualitative analysis revealed three themes: no control over body weight, limitation in clothing options and discomfort towards medical equipment.

Influence of the fear of death on body image evaluation

Background: Research on the consequences of fear of death often consists of classical investigations within the sphere of social psychology. However, the aspect of body image regarding this issue remains largely unexplored. Aim of the study: The goal of the conducted experiment was to examine the mechanisms reducing the fear of death. The respondents had two options to choose from: (1) increasing self-esteem in terms of physical attractiveness, or (2) lowering the rating of the body image presented in the photographs. Material and methods: The study was conducted using the following tests: (1) the Memory Test, developed by Łukaszewski and Buczny; (2) the Body-Esteem Scale (BE S), developed by Franzoi and Shields; (3) the UMACL Mood Adjective Checklist, developed by Mathews, Chamberlain, and Jones; and (4) the Body Shape Attractiveness Questionnaire. In this report, we present results of an analysis of 221 respondents (108 women and 113 men). Results: Death-related thoughts influence the perception of female body attractiveness. Respondents with awareness of mortality salience rated the attractiveness of body shape as lower than respondents from the control group. Conclusions: The present experiment confirmed the influence of fear of death on the evaluation of cultural and biological standards of female physical attractiveness, as well as, the hesitation of participants’ self-esteem and mood related to sex. The lack of critical evaluation of others and a positive self-evaluation effectively protects an individual against mood deterioration, and these effects were observed among men. However, these mechanisms do not apply to women, since women reacted critically to both body shapes in the photographs and their own bodies.

An exploration of 'fitspiration' content on YouTube and its impacts on consumers

The 'Fitspiration' movement may endorse problematic body image and behaviour. This study aims to expand the understanding of 'fitspiration' by examining its presence on YouTube. Analysis was conducted in accordance with Tiggemann and Zaccardo and Santarossa et al. Thematic analysis of videos revealed three themes; 'Fitness and beauty', 'Trust me-I'm a YouTuber', and 'Health for the right reasons'. Thematic analysis of comments revealed themes 'YouTube fitness community', 'Body appearance dissatisfaction', and 'YouTuber fitness role models'. Fitness YouTubers were found to promote unhealthy behaviours to achieve fitness, and commenters expressed belief in and replication of their advice.

The effect of exposure to parodies of thin-ideal images on young women's body image and mood

Although social networking services typically promote the thin beauty ideal for women, they also provide an opportunity for users to challenge this dominant ideal in unique and novel ways. This study aimed to experimentally investigate the influence of exposure to humorous, parody images of thin-ideal celebrity Instagram posts on women's body satisfaction and mood compared to exposure to thin-ideal celebrity posts alone. Participants were 102 women aged 18-30 years who were randomly allocated to view either a set of Instagram images of thin-ideal celebrity posts or humorous parody images of the same celebrity posts. Results indicated that acute exposure to parody images led to increased body satisfaction and positive mood (happiness) compared to exposure to the thin-ideal celebrity images alone. No group differences were found on levels of trait appearance comparison or social media literacy, and the findings were not moderated by trait levels of thin-ideal internalisation. The findings provide preliminary support for the use of humorous, parody images for improving body satisfaction and positive mood in young women and add to the small but growing body of research highlighting potentially positive effects of social media.

A Qualitative Study Exploring Female College Students' Instagram Use and Body Image

Research demonstrates that mainstream media negatively impacts women's body image; less is known about social media, specifically Instagram. The purpose of the study was to explore how female college students use Instagram, and if using Instagram impacts body image. Since little is known, a descriptive qualitative approach was used. Six face-to-face focus groups with a total of 27 participants, aged 18-22 years, were conducted. The data were analyzed using a thematic analysis. Three themes related to Instagram use emerged: effortful posting, promotion of self, and seeking engagement. Participants put substantial effort into what they were posting, were careful to select the best images of themselves, and placed a lot of importance on receiving likes and comments. Three themes surfaced pertaining to body image: responding to beauty ideals, comparing self with others, and display of self. Participants recognized and strove to adhere to a variety of beauty standards; some discussed experiencing appearance dissatisfaction when trying to measure up to these ideals. Moreover, participants frequently compared their looks or the number of likes/comments with others. Additionally, when posting photos of self, participants took an audience perspective, expressing concern with how others perceived their appearance.

Women's Use of Social Media: What Is the Evidence About Their Impact on Weight Management and Body Image?

PURPOSE OF THE REVIEW

This review aims to summarize recent research on the effects of social media-delivered weight management interventions on weight loss and the impact of social media use on body image concerns in women and adolescent girls.

RECENT FINDINGS

Evidence supports the feasibility, but not the efficacy, of studies using single-component social media-delivered weight management interventions (i.e., including no other modes of intervention delivery) in women. Studies conducted in adolescent girls and women suggest that the impact of social media on body image outcomes is mostly detrimental, but is dependent on the context (e.g., exposure to idealized social media appearance images), peers' feedback, and constructs, such as appearance comparison tendency. More research is needed to conclude on the efficacy of social media-delivered interventions on both weight and body image outcomes and to understand how and when exposure to social media could promote effective weight management and also advocate positive body image in women.

Body image dissatisfaction in patients with inflammatory bowel disease: a systematic review

BACKGROUND AND AIMS

Little is known about the relationship between inflammatory bowel disease (IBD) and body image. The aim of this systematic review was to summarise the evidence on body image dissatisfaction in patients with IBD across four areas: (1) body image tools, (2) prevalence, (3) factors associated with body image dissatisfaction in IBD and (4) association between IBD and quality of life.

METHODS

Two reviewers screened, selected, quality assessed and extracted data from studies in duplicate. EMBASE, MEDLINE, PsycINFO and Cochrane CENTRAL were searched to April 2018. Study design-specific critical appraisal tools were used to assess risk of bias. Narrative analysis was undertaken due to heterogeneity.

RESULTS

Fifty-seven studies using a body image tool were included; 31 for prevalence and 16 and 8 for associated factors and association with quality of life, respectively. Studies reported mainly mean or median scores. Evidence suggested female gender, age, fatigue, disease activity and steroid use were associated with increased body image dissatisfaction, which was also associated with decreased quality of life.

CONCLUSION

This is the first systematic review on body image in patients with IBD. The evidence suggests that body image dissatisfaction can negatively impact patients, and certain factors are associated with increased body image dissatisfaction. Greater body image dissatisfaction was also associated with poorer quality of life. However, the methodological and reporting quality of studies was in some cases poor with considerable heterogeneity. Future IBD research should incorporate measurement of body image dissatisfaction using validated tools.

Female bodybuilders on Instagram: Negotiating an empowered femininity

Strength and femininity have in many ways been culturally constructed as two mutually exclusive phenomena. This paper considers how Instagram facilitates female body objectification and surveillance through an examination of female bodybuilders whose muscular bodies represent both resistance against and conformity to dominant cultural notions around women as fragile, weak, and subservient. We reveal how surveillance over the bodies of female bodybuilders on Instagram functions to reposition them as more (hetero)normatively feminine by encouraging them to present bodies which are ornamented, sexualized, and passive. We also reveal how female bodybuilders practise self-surveillance on Instagram by simultaneously resisting and conforming to this surveillance. In the process, these women manage to redefine femininity for themselves in ways which problematize dualistic notions around strength and femininity.

Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research

Compared with self-help bibliotherapy, little is known about the efficacy of creative bibliotherapy or the mechanisms of its possible efficacy for eating disorders or any other mental health condition. It is clear, however, that fiction is widely used informally as a therapeutic or antitherapeutic tool and that it has considerable potential in both directions, with a possibly significant distinction between the effects of reading fiction about eating disorders (which may-contrary to theoretical predictions-be broadly negative in effect) or one's preferred genre of other fiction (which may be broadly positive). Research on creative bibliotherapy, especially systematic experimental research, is lacking and requires a medical humanities approach, drawing on knowledge and methods from psychology and cognitive literary studies as well as clinical disciplines to expand our understanding of how the dynamic processes of interpretation mediate between textual structures and characteristics of mental health and illness.

Social media literacy protects against the negative impact of exposure to appearance ideal social media images in young adult women but not men

Frequent exposure to appearance ideal social media is associated with body dissatisfaction. We hypothesised that commercial and peer social media literacy would protect against the negative impact of exposure to social media appearance ideal images on young adults' body image. The study was presented as an investigation of alcohol promotion on social media. Participants were 187 women (M_age = 24.6, SD = 3.7) and 187 men (M_age = 22.8, SD = 3.9) who viewed gender-matched alcohol-related appearance ideal social media images or control images containing alcohol only. Social media literacy was assessed prior to image exposure and body satisfaction measured before and after exposure. A negative effect of ideal image exposure on body satisfaction was observed in both women and men. In women only, commercial-social media literacy moderated the negative effect of exposure, independent of internalization or body comparison. Inclusion of social media literacy skills in prevention interventions is supported.

Analyzing big data in social media: Text and network analyses of an eating disorder forum

OBJECTIVE

Social media plays an important role in everyday life of young people. Numerous studies claim negative effects of social media and media in general on eating disorder risk factors. Despite the availability of big data, only few studies have exploited the possibilities so far in the field of eating disorders.

METHOD

Methods for data extraction, computerized content analysis, and network analysis will be introduced. Strategies and methods will be exemplified for an ad-hoc dataset of 4,247 posts and 34,118 comments by 3,029 users of the proed forum on Reddit.

RESULTS

Text analysis with latent Dirichlet allocation identified nine topics related to social support and eating disorder specific content. Social network analysis describes the overall communication patterns, and could identify community structures and most influential users. A linear network autocorrelation model was applied to estimate associations in language among network neighbors. The supplement contains R code for data extraction and analyses.

DISCUSSION

This paper provides an introduction to investigating social media data, and will hopefully stimulate big data social media research in eating disorders. When applied in real-time, the methods presented in this manuscript could contribute to improving the safety of ED-related online communication.

How Social and Mass Media Relate to Youth's Self-Sexualization: Taking a Cross-National Perspective on Rewarded Appearance Ideals

Although media exposure has been related to cognitive preoccupation with appearance, research rarely investigated adolescents' behavioral self-sexualization. To address this gap, the present study among 12- to 16-year-olds (N = 1527; 50.2% girls) in Austria, Belgium, Spain, and South-Korea (1) investigates whether different types of media use relate to self-sexualization, (2) explores the explanatory value of rewarded appearance ideals, and (3) considers culture and gender as moderating factors. Despite cultural variation, a general trend of increasing self-sexualization with social media use and magazine reading appeared across the countries. Moreover, women's magazine reading and rewards were related to self-sexualization among all the girls across the countries, which suggests that girls may be more vulnerable to the examined effects. Overall, this study provides a better understanding of the unique contribution of specific media genres to youth's self-sexualization and points at the importance of social media use in girls' and boys' engagement in sexualizing appearance behaviors across four countries.

Literary reading and eating disorders: survey evidence of therapeutic help and harm

BACKGROUND

There is growing evidence for the efficacy of self-help bibliotherapy as a treatment for eating disorders, although little understanding of how specific linguistic characteristics may enhance or constrain its effects. Meanwhile, 'creative bibliotherapy' (the therapeutic use of fiction, poetry, or sometimes film, rather than self-help books) is widely practised, but even more poorly understood than the self-help variety: although a range of theoretical models exist, claims of the healing power of literature are far more commonly made than tested.

METHODS

An online survey including quantitative (forced-choice) and qualitative (free-response) items was designed and administered in collaboration with the charity Beat to investigate the connections between respondents' reading habits and their mental health, with a focus on eating disorders, and attracted 885 respondents. Responses to two sequences of questions, exploring the differential effects of fiction about eating disorders versus respondents' preferred genre of other fiction on the dimensions of mood, self-esteem, feelings about one's body, and diet and exercise habits, were analysed using a 2 × 2 repeat measures factorial ANOVA design for each of the four dependent variables.

RESULTS

Surprisingly, fiction about eating disorders was perceived by respondents as broadly detrimental to mood, self-esteem, feelings about their bodies, and diet and exercise habits, while respondents' preferred genre of other fiction was experienced as beneficial to mood and broadly neutral on the other three dimensions. The free-response data added detail to these core findings, as well as suggesting numerous other possible effects and mechanisms, drawing attention to the roles of positive and negative feedback structures and of highly selective interpretive filtering, and highlighting the dangers of 'self-triggering': using books to deliberately exacerbate an eating disorder.

CONCLUSIONS

The findings directly challenge existing theoretical models of creative-bibliotherapeutic mechanisms, which tend to insist on the importance of a close match between the reader's and the protagonist's situations. They point the way forward for a new programme of clinical research and practice by suggesting other ways to conceive of how embodied cognitive acts of textually cued interpretation may intervene in the psychopathology of an eating disorder - for good and for ill.