The importance of perceptual experience in the esthetic appreciation of the body

The Primacy of Ethics in Aesthetic Medicine: A Review

Background

The landscape of modern aesthetic medicine has witnessed a paradigm shift from traditional doctor-led care to a consumer-driven model, presenting a plethora of ethical challenges. This review discusses the ethical dimensions of medical aesthetics, exploring the implications of consumer demand, societal influences, and technological advancements on patient care and well-being.

Methods

Drawing upon a comprehensive analysis of existing literature, this review synthesizes evidence regarding the rise of aesthetic medicine, ethical challenges encountered in practice, and the implications of social media and marketing in shaping patient perceptions and decision-making.

Results

Aesthetic medicine confronts unique ethical challenges stemming from its elective nature and the pervasive influence of societal beauty standards. Concerns include the commodification of beauty, conflicts of interest, limited evidence-base of treatments, and the rise of nonphysician providers. Moreover, the evolving role of social media influencers and medical marketing raises ethical dilemmas regarding transparency, patient autonomy, and professional integrity.

Conclusions

The ethical landscape of aesthetic medicine necessitates a proactive approach to address emerging challenges and safeguard patient well-being. Guided by principles of autonomy, beneficence, nonmaleficence, and justice, recommendations are proposed to enhance informed consent practices, mitigate appearance anxiety, facilitate shared decision-making, and promote responsible use of social media. Professional societies are urged to establish clear ethical guidelines and standards to uphold professionalism and patient trust in the field of aesthetic medicine.

Changes in the Prevalence of Thin Bodies Bias Young Women's Judgments About Body Size

Body dissatisfaction is pervasive among young women in Western countries. Among the many forces that contribute to body dissatisfaction, the overrepresentation of thin bodies in visual media has received notable attention. In this study, we proposed that prevalence-induced concept change may be one of the cognitive mechanisms that explain how beauty standards shift. We conducted a preregistered online experiment with young women (N = 419) and found that when the prevalence of thin bodies in the environment increased, the concept of being overweight expanded to include bodies that would otherwise be judged as "normal." Exploratory analyses revealed significant individual differences in sensitivity to this effect, in terms of women's judgments about other bodies as well as their own. These results suggest that women's judgments about other women's bodies are biased by an overrepresentation of thinness and lend initial support to policies designed to increase size-inclusive representation in the media.

Experience-dependent reshaping of body gender perception

Protracted exposure to specific stimuli causes biased visual aftereffects at both low- and high-level dimensions of a stimulus. Recently, it has been proposed that alterations of these aftereffects could play a role in body misperceptions. However, since previous studies have mainly addressed manipulations of body size, the relative contribution of low-level retinotopic and/or high-level object-based mechanisms is yet to be understood. In three experiments, we investigated visual aftereffects for body-gender perception, testing for the tuning of visual aftereffects across different characters and orientation. We found that exposure to a distinctively female (or male) body makes androgynous bodies appear as more masculine (or feminine) and that these aftereffects were not specific for the individual characteristics of the adapting body (Exp.1). Furthermore, exposure to only upright bodies (Exp.2) biased the perception of upright, but not of inverted bodies, while exposure to both upright and inverted bodies (Exp.3) biased perception for both. Finally, participants' sensitivity to body aftereffects was lower in individuals with greater communication deficits and deeper internalization of a male gender role. Overall, our data reveals the orientation-, but not identity-tuning of body-gender aftereffects and points to the association between alterations of the malleability of body gender perception and social deficits.

‘When hunger makes everything better looking!’: The effect of hunger on the aesthetic appreciation of human bodies, faces and objects

Background

Research evidence suggests that physiological state of hunger might affect preference for female body weight, such that hungrier, compared to satiate, men prefer heavier body weight and rate as more attractive heavier female figures. Here, we seek to extend these findings by comparing the effects of fasting and snack on aesthetics judgements of the bodies and faces of conspecifics and of objects in a sample of female and male participants.

Methods

Forty-four participants (women: n = 21, mean age = 23.70 yrs ± 0.62) provided aesthetic liking judgments of round and slim human bodies, faces and objects, under at least 12 h of overnight fasting and immediately after having eaten a snack (i.e., bananas). An anthropometric measure of adiposity (i.e., Body Mass Index, BMI) was also collected from each observer.

Results

Overall, we found that participants’ aesthetic judgements were higher for slim stimuli compared to round ones. However, after fasting, participants rated round stimuli as more attractive compared to when they had a snack. This hunger-based shift in ratings not only was apparent when stimuli depicted a human body or face, but also when they depicted an object, thus suggesting a general modification of observers’ aesthetic preference related to hunger. Importantly, this effect was modulated by participants’ BMI so that only participants with a high BMI provided higher aesthetic judgements for round stimuli after fasting than after a snack.

Conclusions

Our results demonstrated that both the modification of the physiological state and the individual differences in adiposity level of the observers might affect the aesthetic appreciation of the external world.

Perception and Appreciation of Tactile Objects: The Role of Visual Experience and Texture Parameters

This exploratory study was designed to examine the effects of visual experience and specific texture parameters on both discriminative and aesthetic aspects of tactile perception. To this end, the authors conducted two experiments using a novel behavioral (ranking) approach in blind and (blindfolded) sighted individuals. Groups of congenitally blind, late blind, and (blindfolded) sighted participants made relative stimulus preference, aesthetic appreciation, and smoothness or softness judgment of two-dimensional (2D) or three-dimensional (3D) tactile surfaces through active touch. In both experiments, the aesthetic judgment was assessed on three affective dimensions, Relaxation, Hedonics, and Arousal, hypothesized to underlie visual aesthetics in a prior study. Results demonstrated that none of these behavioral judgments significantly varied as a function of visual experience in either experiment. However, irrespective of visual experience, significant differences were identified in all these behavioral judgments across the physical levels of smoothness or softness. In general, 2D smoothness or 3D softness discrimination was proportional to the level of physical smoothness or softness. Second, the smoother or softer tactile stimuli were preferred over the rougher or harder tactile stimuli. Third, the 3D affective structure of visual aesthetics appeared to be amodal and applicable to tactile aesthetics. However, analysis of the aesthetic profile across the affective dimensions revealed some striking differences between the forms of appreciation of smoothness and softness, uncovering unanticipated substructures in the nascent field of tactile aesthetics. While the physically softer 3D stimuli received higher ranks on all three affective dimensions, the physically smoother 2D stimuli received higher ranks on the Relaxation and Hedonics but lower ranks on the Arousal dimension. Moreover, the Relaxation and Hedonics ranks accurately overlapped with one another across all the physical levels of softness/hardness, but not across the physical levels of smoothness/roughness. These findings suggest that physical texture parameters not only affect basic tactile discrimination but differentially mediate tactile preferences, and aesthetic appreciation. The theoretical and practical implications of these novel findings are discussed.

Use of a real-life practical context changes the relationship between implicit body representations and real body measurements

A mismatch exists between people's mental representations of their own body and their real body measurements, which may impact general well-being and health. We investigated whether this mismatch is reduced when contextualizing body size estimation in a real-life scenario. Using a reverse correlation paradigm, we constructed unbiased, data-driven visual depictions of participants' implicit body representations. Across three conditions-own abstract, ideal, and own concrete body-participants selected the body that looked most like their own, like the body they would like to have, or like the body they would use for online shopping. In the own concrete condition only, we found a significant correlation between perceived and real hip width, suggesting that the perceived/real body match only exists when body size estimation takes place in a practical context, although the negative correlation indicated inaccurate estimation. Further, participants who underestimated their body size or who had more negative attitudes towards their body weight showed a positive correlation between perceived and real body size in the own abstract condition. Finally, our results indicated that different body areas were implicated in the different conditions. These findings suggest that implicit body representations depend on situational and individual differences, which has clinical and practical implications.

Perceived match between own and observed models' bodies: influence of face, viewpoints, and body size

People are generally unable to accurately determine their own body measurements and to translate this knowledge to identifying a model/avatar that best represents their own body. This inability has not only been related to health problems (e.g. anorexia nervosa), but has important practical implications as well (e.g. online retail). Here we aimed to investigate the influence of three basic visual features—face presence, amount of viewpoints, and observed model size—on the perceived match between own and observed models’ bodies and on attitudes towards these models. Models were real-life models (Experiment 1) or avatar models based on participants’ own bodies (Experiment 2). Results in both experiments showed a strong effect of model size, irrespective of participants’ own body measurements. When models were randomly presented one by one, participants gave significantly higher ratings to smaller- compared to bigger-sized models. The reverse was true, however, when participants observed and compared models freely, suggesting that the mode of presentation affected participants’ judgments. Limited evidence was found for an effect of facial presence or amount of viewpoints. These results add evidence to research on visual features affecting the ability to match observed bodies with own body image, which has biological, clinical, and practical implications.

The malleability of beauty: perceptual adaptation

Beauty has many facets, and research shows that there are many biologic, psychologic, cultural, and social aspects that influence how beauty and attractiveness are perceived. Beauty preferences are, in part, an effect of a rudimentary cognitive process that appears quite early in life, with humans having a seemingly automatic ability to categorize a person as beautiful or not. This instantaneous capability of human beauty categorization is partially determined by a function of physical features, such as facial averageness, symmetry, and skin homogeneity. For decades, the mass media platform has introduced certain criteria to what establishes beauty, and more recently, social media, instant photo sharing, and editing apps have further influenced how society adapts to beauty principles.

Implicit and explicit changes in body satisfaction evoked by body size illusions: Implications for eating disorder vulnerability in women

Dissatisfaction with one's body is a widespread issue in modern society and has been linked to vulnerability for developing eating disorders. Recent studies have demonstrated a direct relationship between body perception and body satisfaction by manipulating perceived body size using multisensory body illusions. However, how these body size illusions influence implicit affective experience has not previously been examined. The current experiment used an established full-body ownership illusion paradigm to induce feelings of illusory obesity in male and female participants. The effects of illusory obesity on explicit and implicit body satisfaction were measured in naïve participants across two separate experiments. In terms of explicit measures, owning an obese body decreased body satisfaction, and owning a slimmer body increased body satisfaction in females but not in males. However, implicit feelings regarding the body were only influenced by the synchrony of the touch and not the size of the body in the illusion. These results suggest that implicit and explicit affective experiences of the body may be mediated by different factors. In addition, these findings may have clinical implications because both implicit and explicit changes in affective experience of the body were related to behaviours and thoughts associated with disordered eating in a non-clinical sample.

Visual attention mediates the relationship between body satisfaction and susceptibility to the body size adaptation effect

Body size misperception–the belief that one is larger or smaller than reality–affects a large and growing segment of the population. Recently, studies have shown that exposure to extreme body stimuli results in a shift in the point of subjective normality, suggesting that visual adaptation may be a mechanism by which body size misperception occurs. Yet, despite being exposed to a similar set of bodies, some individuals within a given geographical area will develop body size misperception and others will not. The reason for these individual difference is currently unknown. One possible explanation stems from the observation that women with lower levels of body satisfaction have been found to pay more attention to images of thin bodies. However, while attention has been shown to enhance visual adaptation effects in low (e.g. rotational and linear motion) and high level stimuli (e.g., facial gender), it is not known whether this effect exists in visual adaptation to body size. Here, we test the hypothesis that there is an indirect effect of body satisfaction on the direction and magnitude of the body fat adaptation effect, mediated via visual attention (i.e., selectively attending to images of thin over fat bodies or vice versa). Significant mediation effects were found in both men and women, suggesting that observers’ level of body satisfaction may influence selective visual attention to thin or fat bodies, which in turn influences the magnitude and direction of visual adaptation to body size. This may provide a potential mechanism by which some individuals develop body size misperception–a risk factor for eating disorders, compulsive exercise behaviour and steroid abuse–while others do not.

Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory

Although overweight and obesity are widespread across most of the developed world, a considerable body of research has now accumulated, which suggests that adiposity often goes undetected. A substantial proportion of individuals with overweight or obesity do not identify they are overweight, and large numbers of parents of children with overweight or obesity fail to identify their child as being overweight. Lay people and medical practitioners are also now poor at identifying overweight and obesity in others. A visual normalization theory of the under-detection of overweight and obesity is proposed. This theory is based on the notion that weight status is judged relative to visual body size norms. Because larger body sizes are now common, this has caused a recalibration to the range of body sizes that are perceived as being 'normal' and increased the visual threshold for what constitutes 'overweight'. Evidence is reviewed that indicates this process has played a significant role in the under-detection of overweight and obesity. The public health relevance of the under-detection of overweight and obesity is also discussed.

Independent Aftereffects of Fat and Muscle: Implications for neural encoding, body space representation, and body image disturbance

Although research addressing body size misperception has focused on socio-cognitive processes, such as internalization of the “ideal” images of bodies in the media, the perceptual basis of this phenomenon remains largely unknown. Further, most studies focus on body size per se even though this depends on both fat and muscle mass – variables that have very different relationships with health. We tested visual adaptation as a mechanism for inducing body fat and muscle mass misperception, and assessed whether these two dimensions of body space are processed independently. Observers manipulated the apparent fat and muscle mass of bodies to make them appear “normal” before and after inspecting images from one of four adaptation conditions (increased fat/decreased fat/increased muscle/decreased muscle). Exposure resulted in a shift in the point of subjective normality in the direction of the adapting images along the relevant (fat or muscle) axis, suggesting that the neural mechanisms involved in body fat and muscle perception are independent. This supports the viability of adaptation as a model of real-world body size misperception, and extends its applicability to clinical manifestations of body image disturbance that entail not only preoccupation with thinness (e.g., anorexia nervosa) but also with muscularity (e.g., muscle dysmorphia).

Altered exposure-related reshaping of body appreciation in adolescent patients with anorexia nervosa

Several studies suggest a relation between repeated exposure to extremely thin bodies in media and the perceptual and emotional disturbances of body representation in anorexia nervosa (AN). In this study, we utilized an exposure paradigm to investigate how perceptual experience modulates body appreciation in adolescents with AN as compared to healthy adolescents. Twenty AN patients and 20 healthy controls were exposed to pictures of thin or round models and were then required to express liking judgments about bodies of variable weight. Brief exposure to round models increased the liking judgments of round bodies but not those of thin bodies in healthy adolescents. Furthermore, exposure to round models increased the liking judgments of both thin and round bodies in adolescents with AN. Patients did not show any change of liking judgments after exposure to thin models. These results point to weak norm-based reshaping of body appreciation in AN patients.

Different contributions of visual and motor brain areas during liking judgments of same- and different-gender bodies

Previous neuroimaging studies have shown that body aesthetic appreciation involves the activation of both visual and motor areas, supporting a role of sensorimotor embodiment in aesthetic processing. Causative evidence, however, that neural activity in these areas is crucial for reliable aesthetic body appreciation has so far provided only for extrastriate body area (EBA), while the functional role played by premotor regions remained less clear. Here, we applied short trains of repetitive transcranial magnetic stimulation (rTMS) over bilateral dorsal premotor cortex (dPMC) and EBA during liking judgments of female and male bodies varying in weight and implied motion. We found that both dPMC and EBA are necessary for aesthetic body appreciation, but their relative contribution depends on the model's gender. While dPMC-rTMS decreased the liking judgments of same-, but not of different-gender models, EBA-rTMS increased the liking judgments of different-, but not of same-gender models. Relative contributions of motor and visual areas may reflect processing of diverse aesthetic properties, respectively implied motion vs. body form, and/or greater sensorimotor embodiment of same- vs. different-gender bodies. Results suggest that aesthetic body processing is subserved by a network of motor and visual areas, whose relative contribution may depend on the specific stimulus and task.

The power within: The experimental manipulation of power interacts with trait BDD symptoms to predict interoceptive accuracy

BACKGROUND AND OBJECTIVES

This study tested whether relatively low levels of interoceptive accuracy (IAcc) are associated with body dysmorphic disorder (BDD) symptoms. Additionally, given research indicating that power attunes individuals to their internal states, we sought to determine if state interoceptive accuracy could be improved through an experimental manipulation of power..

METHOD

Undergraduate women (N = 101) completed a baseline measure of interoceptive accuracy and then were randomized to a power or control condition. Participants were primed with power or a neutral control topic and then completed a post-manipulation measure of state IAcc. Trait BDD symptoms were assessed with a self-report measure.

RESULTS

Controlling for baseline IAcc, within the control condition, there was a significant inverse relationship between trait BDD symptoms and interoceptive accuracy. Continuing to control for baseline IAcc, within the power condition, there was not a significant relationship between trait BDD symptoms and IAcc, suggesting that power may have attenuated this relationship. At high levels of BDD symptomology, there was also a significant simple effect of experimental condition, such that participants in the power (vs. control) condition had better interoceptive accuracy. These results provide initial evidence that power may positively impact interoceptive accuracy among those with high levels of BDD symptoms..

LIMITATIONS

This cross-sectional study utilized a demographically homogenous sample of women that reflected a broad range of symptoms; thus, although there were a number of participants reporting elevated BDD symptoms, these findings might not generalize to other populations or clinical samples.

CONCLUSIONS

This study provides the first direct test of the relationship between trait BDD symptoms and IAcc, and provides preliminary evidence that among those with severe BDD symptoms, power may help connect individuals with their internal states. Future research testing the mechanisms linking BDD symptoms with IAcc, as well as how individuals can better connect with their internal experiences is needed..

The effects of body exposure on self-body image and esthetic appreciation in anorexia nervosa

Repeated exposures to thin-idealized body shapes may alter women's perceptions of what normal (e.g., accepted) and ideal (e.g., desired) bodies in a cultural environment look like. The aim of the present study was to investigate whether exposure to thin and round body shapes may change the subsequent esthetic appreciation of others' bodies and the perceptual and cognitive-affective dimensions of self-body image in patients suffering from anorexia nervosa (AN). Thirteen AN patients and 13 matched healthy controls were exposed to pictures of either thin or round unfamiliar body models and, before and after exposure, they were required to either express liking judgments about round and slim figures of unfamiliar bodies (esthetic task) or to adjust distorted pictures of their own body to their perceptual (How do you see yourself?), affective (How do you feel yourself?), metacognitive (How do others see you?) and ideal (How would you like to look like?) body image (self-body adjustment task). Brief exposures to round models increased liking judgments of round figures in both groups. However, only in AN patients, exposure to round models induced an increase in thin figures liking, which positively correlated with their preoccupation with dieting. Furthermore, exposure to round bodies in AN patients, but not in controls, increased the distortion for the perceptual body image and decreased the size of the ideal one. No differences between the two groups were obtained after adaptation to thin models. Our results suggest that AN patients' perception of their own and others' body is more easily malleable by exposure to round figures as compared to controls. Crucially, this mechanism may strongly contribute to the development and maintenance of self-body image disturbances.

Distinct contributions of extrastriate body area and temporoparietal junction in perceiving one's own and others' body

The right temporoparietal cortex plays a critical role in body representation. Here, we applied repetitive transcranial magnetic stimulation (rTMS) over right extrastriate body area (EBA) and temporoparietal junction (TPJ) to investigate their causative roles in perceptual representations of one's own and others' body. Healthy women adjusted size-distorted pictures of their own body or of the body of another person according to how they perceived the body (subjective task) or how others perceived it (intersubjective task). In keeping with previous reports, at baseline, we found an overall underestimation of body size. Crucially, EBA-rTMS increased the underestimation bias when participants adjusted the images according to how others perceived their own or the other woman's body, suggesting a specific role of EBA in allocentric body representations. Conversely, TPJ-rTMS increased the underestimation bias when participants adjusted the body of another person, either a familiar other or a close friend, in both subjective and intersubjective tasks, suggesting an involvement of TPJ in representing others' bodies. These effects were body-specific, since no TMS-induced modulation was observed when participants judged a familiar object. The results suggest that right EBA and TPJ play active and complementary roles in the complex interaction between the perceptions of one's own and other people's body.

Analysis of Attentional Bias towards Attractive and Unattractive Body Regions among Overweight Males and Females: An Eye-Movement Study

Background

Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others’ attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias.

Methods/Design

We analyzed eye movements in 30 overweight individuals (18 females) and 28 normal-weight individuals (16 females) with respect to the participants’ own pictures as well as gender- and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires.

Discussion

The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive compared to unattractive regions of both their own and the control body. For one’s own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.

Visual exposure to obesity: Experimental effects on attraction toward overweight men and mate choice in females

BACKGROUND

Cultural differences in ideal body weight are well established, but less research has examined attraction toward potential mates of heavier body weights. We examined whether exposure to obesity increases physical attraction toward overweight men.

METHODS

In Studies 1 and 2, we examined the effect that exposure to obese vs healthy weight men had on female attraction toward an overweight man. Study 3 examined whether females who are regularly exposed to males of heavier body weights reported a greater attraction toward overweight men. Study 4 tested whether females in an online dating study were more likely to choose to date an overweight man, after having been exposed to obesity.

RESULTS

Exposure to obesity altered visual perceptions of what normal and therefore healthy body weights were and this resulted in greater attraction toward an overweight man (Studies 1 and 2). Females regularly exposed to men of heavier body weight reported a greater attraction toward overweight men (Study 3). After exposure to obesity, females in an online dating study were more likely to choose to date an overweight man ahead of a healthy weight man (Study 4).

CONCLUSIONS

Exposure to male obesity increases female attraction toward overweight men and may affect mate choice.

The factor structure and psychometric properties of the Italian version of the Acceptance of Cosmetic Surgery Scale

The current study examined the validity of the Italian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005) in a sample of 378 Italian adult women. A series of confirmatory factor analyses were conducted. A three-factor solution provided the best fit to the data and confirmed the Intrapersonal, Social, and Consider dimensions. The three factors were strongly inter-correlated. Cronbach's alphas were high (all alphas>.86). The scale showed good convergent and discriminant validity (estimated by Composite Reliability and the Average Variance Extracted). The nomological validity of the Italian version of the ACSS was confirmed by its significant correlations with participants' body dissatisfaction and sociocultural influences (internalization of thin ideals and perceived media pressure). The ACSS seems to be a useful measure of acceptance of cosmetic surgery in the Italian context. This instrument can be used with Italian speakers for research, health promotion, and preventive interventions.

Gender differences in the neural underpinning of perceiving and appreciating the beauty of the body

Although previous studies have suggested a certain degree of right hemisphere dominance for the response of extrastriate body area (EBA) during body perception, recent evidence suggests that this functional lateralization may differ between men and women. It is unknown, however, whether and how gender differences in body perception affect appreciating the beauty of the body of conspecifics. Here, we applied five 10-Hz repetitive transcranial magnetic stimulation (rTMS) pulses over left and right EBA and over the vertex to investigate the contribution of visual body representations in the two hemispheres on esthetic body perception. Female and male healthy volunteers were requested to judge how much they liked opposite- and same-gender virtual model bodies or to judge their weight, thus allowing us to compare the effects of right- and left-EBA rTMS on esthetic (liking) and perceptual (weight) judgments of human bodies. The analysis of the esthetic judgments provided by women revealed that right-EBA rTMS increased the liking judgments of opposite- but not same-gender models, as compared to both vertex and left EBA stimulation. Conversely, in men the liking judgments of opposite-gender models decreased after virtual disruption of both right and left EBA as compared to vertex stimulation. Crucially, no significant effect was found for the perceptual task, showing that left- and right-EBA rTMS did not affect weight perception. Our results provide evidence of gender difference in the hemispheric asymmetry of EBA in the esthetic processing of human bodies, with women showing stronger right hemisphere dominance in comparison with men.