Emphasizing the "Cultural" in Sociocultural: A Systematic Review of Research on Thin-Ideal Internalization, Acculturation, and Eating Pathology in US Ethnic Minorities

Validation of an adapted Italian-language version of the Sociocultural Attitudes Toward Appearance Questionnaire-3 (SATAQ-3), within a female population: the Sociocultural Attitudes Toward Appearance Questionnaire - Social Media (SATAQ-SM)

Sociocultural Attitudes Towards Appearance Questionnaire-Social Media (SATAQ-SM) is a self-administered questionnaire for the evaluation of social media pressure and internalization of beauty standards. This study aims to validate the SATAQ-SM an adapted Italian version of the Sociocultural Attitudes Towards Appearance Questionnaire third version (SATAQ-3). Confirmatory factor analysis was used to investigate whether the empirical data fitted the four-factor structure of SATAQ-3. Assessment of goodness-of-fit was based on standard model fit criteria: relative χ2 value (χ2/df), Root Mean-Squared Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI). Internal consistency was assessed using McDonald's omega. Criterion validity was calculated by correlating the SATAQ-SM factors scores with the total score of the Rosenberg self-esteem scale (RSES) and Eating Attitudes Test (EAT-26). Four-hundred and eighty-five females agreed to participate in the study. The four-factor model appears to be confirmed by the fit indices: χ2/df = 3.73, RMSEA = 0.07, CFI = 0.99 and TLI = 0.99. All the items defining the four factors had a factor loading of ≥0.40. McDonald's omega of the entire questionnaire was equal to 0.95 and for the four subscales it did not assume values lower than 0.81. The correlations between the factor score of SATAQ-SM and the RSES were all negative and statistically relevant (p < 0.001); the correlations between the scores of the SATAQ-SM subscales and the total score of the EAT-26 are all positive and statistically significant. SATAQ-SM demonstrated good psychometric properties to assess the influence of social media on body image perception related to social media.

'E koekoe te Tūī, e ketekete te Kākā, e kuku te Kererū, The Tūī chatters, the Kākā cackles, and the Kererū coos': Insights into explanatory factors, treatment experiences and recovery for Māori with eating disorders - A qualitative study

BACKGROUND

Eating disorders are as common in Māori, the Indigenous people of Aotearoa-New Zealand, as they are in non-Māori; however, research has focused on the experiences of non-Māori. This paper will describe explanatory factors, treatment experiences and what helps with recovery for Māori.

METHODS

Kaupapa Māori research methodology informed the methods and analysis. Fifteen semi-structured interviews comprised thirteen Māori participants with eating disorders (anorexia nervosa, bulimia nervosa and binge eating disorder) and two whānau (support network) members. A thematic analysis was undertaken by a first cycle of coding that used deductive structural coding to identify data describing participants' perceived causes of eating disorders, their experience of treatment and recovery. A second cycle of coding used inductive analysis with descriptive and pattern coding.

RESULTS

Three overarching themes were antecedents (cumulative exposure), treatment (a system of complexities) and recovery (resource empowerment). Antecedents comprised cumulative exposure to body and sporting ideals and adversity as causal factors of eating disorders. In the treatment theme, a system of complexities critiqued rural settings for generalised mental health services, allocation of Māori cultural support, the economic burden of treatment, culturally incongruent treatment (methods, values) and a weight-focused discharge criterion. Recovery (resource empowerment) found appropriate health information, self-determination and connection to Māori culture and whānau aspirations helped with recovery.

CONCLUSION

The diversity of birdcalls reminds us of the individuality of eating disorders. Health practitioners are reminded that just as the Tūī, Kākā and Kererū possess their own unique birdcalls, so do Māori with eating disorders and their whānau have their own experiences, needs and required treatment responses.

Digital Mental Health Interventions: Differences in Diet Culture Intervention Framing

Diet culture is a societal norm that ranks thin bodies as superior to other body types and has been associated with negative outcomes, such as eating disorders. Wellness has evolved into a term that is often used to promote diet culture messages. One possible way to combat diet culture is through single-session, digital mental health interventions (DMHIs), which allow for increased access to brief public health treatments. The framing of DMHIs is critical to ensure that the target population is reached. Participants (N = 397) were enrolled in a single-session DMHI, which was framed as either a Diet Culture Intervention (n = 201) or a Wellness Resource (n = 196). Baseline group differences in eating disorder pathology, body image, weight stigma concerns, fat acceptance, and demographic characteristics were analyzed. Across groups, participants reported moderately high eating disorder pathology, low-to-moderate levels of body dissatisfaction, moderate levels of fat acceptance, and either very low or very high weight stigma concerns. Participants in the Diet Culture Intervention group reported higher levels of fat acceptance than those in the Wellness Resource group (p < 0.001). No other framing group differences were identified, though post hoc analyses revealed differences based on recruitment source (i.e., social media versus undergraduate research portal). This study found that framing a DMHI as targeting diet culture or as a Wellness Resource can result in the successful recruitment of individuals at risk of disordered eating. Framing a DMHI as a Wellness Resource may increase recruitment of individuals with low levels of fat acceptance, which may be particularly important for dismantling diet culture, disordered eating, and weight stigma concerns. Future research should assess DMHI framing in other populations, such as men and adolescents.

Body Dissatisfaction and Restricted Diet in Chinese Adolescents: A Longitudinal Analysis

Background/Objective

Body dissatisfaction and restricted diet frequently co-occur among adolescents. However, the exact temporal relationship between the two is unclear. Furthermore, most relevant studies concentrate on Western cultural backgrounds, with only a few investigations conducted in many non-Western developing countries, including China. Therefore, this study aimed to investigate the mutual relationship between body dissatisfaction and restricted diet among Chinese adolescents.

Patients/Methods

We recruited a sample of 672 middle school students from China (358 females, mean age = 14.33±0.94) and collected self-reported measures of body dissatisfaction and restricted diet at three-time points (with a five-month interval between each). We used cross-lagged models to examine the bidirectional relationship between body dissatisfaction and restricted diet.

Results

(1) Both cross-sectional and cross-lagged correlation analysis showed positive correlation between body dissatisfaction and restricted diet (r=0.29-0.36; r=0.25-0.35, Ps<0.001); (2) The cross-lagged effect of body dissatisfaction on restricted diet was significant (β=0.09, 0.13, Ps<0.01), and vice versa (β=0.20, 0.18, Ps<0.001); (3) The differences in the associations between body dissatisfaction and restricted diet across gender were found.

Conclusion/Implications

There is a bidirectional relationship between adolescents' body dissatisfaction and restricted diet. Our findings enrich the existing literature on body image and dietary health, thereby contributing to the reduction of negative body image and disordered eating among adolescents.

Acculturation and eating disorders: a systematic review

PURPOSE

Acculturation, or the dual process of cultural change that takes place due to the interaction between two or more cultural identities, may contribute to the susceptibility of developing an eating disorder (ED). We conducted a systematic review exploring the relationship between acculturation-related constructs and ED pathology.

METHODS

We searched the PsychINFO and Pubmed/Medline databases up to December 2022. Inclusion criteria were: (1) having a measure of acculturation or related constructs; (2) having a measure of ED symptoms; and (3) experiencing cultural change to a different culture with Western ideals. 22 articles were included in the review. Outcome data were synthesized by narrative synthesis.

RESULTS

There was variability in the definition and measure of acculturation in the literature. Overall, acculturation, culture change, acculturative stress, and intergenerational conflict were associated with ED behavioral and/or cognitive symptoms. However, the nature of the specific associations differed depending on the specific acculturation constructs and ED cognitions and behaviors measured. Furthermore, cultural factors (e.g., in-group vs. out-group preferences, generational status, ethnic group, gender) impacted the relationship between acculturation and ED pathology.

DISCUSSION

Overall, this review highlights the need for more precise definitions of the different domains of acculturation and a more nuanced understanding of the specific relationship between various acculturation domains and specific ED cognitions and behaviors. Most of the studies were conducted in undergraduate women and in Hispanic/Latino samples, limiting generalizability of results.

LEVEL OF EVIDENCE

Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Internalization of athletic body ideal as a mediating variable between family influence and body image of young women. A cross-cultural study of polish, Italian, and Ukrainian women

Introduction

Our aim was to analyze the strength of the family's influence on the internalization of the ideal of an athletic figure and, consequently, on the multifactorial image of the body, from the perspective of intercultural differences.

Methods

A total of 488 healthy women aged 19-26; of Polish (154), Ukrainian (228), and Italian (106) took part in the study. The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-4) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ 69) were used to measure athletic ideal internalization and family pressure. The body image of Ukrainian, Polish, and Italian women depends both on the degree of internalization the ideal of an athletic figure and influence of the family.

Results and Discussion

The research also suggests significant differences between the three populations, which may suggest cultural differences between young women living in Eastern, Central, and South European countries.

Acculturative stress and eating disorder psychopathology: A meta-analysis

The present meta-analysis aims to extend Doris and colleagues' (2015) systematic review and address the comprehensive, quantitative gap in the relation between acculturative stress and eating disorder psychopathology reported by studies in the past 20 years. A total of 14 eligible studies were included in our meta-analysis. Across all study samples, there were 2681 participants. The overall relation between eating disorder psychopathology and acculturative stress measurements was examined. Moderation analyses were run to investigate the substantial heterogeneity detected between studies. Results indicated a small effect size for the relationship between eating pathology behaviors and acculturative stress. These results provide insight for clinicians working with individuals who are experiencing acculturative stress, as well as highlight future research directions.

Black adolescents' appearance concerns, depressive symptoms, and self-objectification: Exploring the roles of gender and ethnic-racial identity commitment

There is a dearth of research examining Black adolescents' body image, with even less work examining gender differences or the influence of ethnic-racial identity (ERI) commitment. It is critical to understand how culturally relevant aspects of appearance-beyond commonly measured ideals such as thinness and muscularity-are particularly relevant to Black adolescents. The present study of Black youth (n = 252; 55% girls, 45% boys, ages 13-18, M_age = 15.5) explored the roles of gender and ERI commitment in the associations between skin tone, hair, and facial satisfaction and appearance esteem, depressive symptomatology, and self-objectification. With a few exceptions, satisfaction with skin tone, hair, and face were significantly associated with higher appearance esteem and lower self-objectification and depressive symptoms, even when controlling for weight and muscle tone satisfaction. Findings were similar across genders, with some associations stronger among Black girls relative to boys. Among youth with higher ERI commitment, associations were stronger between skin tone, hair, and facial satisfaction and some indicators of wellbeing. Findings elucidate the role of culturally relevant appearance concerns of Black adolescents and the potential benefits of ERI commitment. This work can inform culturally sensitive research practices and therapeutic interventions related to Black youth's body image experiences.

Internalization of Appearance Ideals and Not Religiosity Indirectly Impacts the Relationship Between Acculturation and Disordered Eating Risk in South and Southeast Asian Women Living in the United States

Objective

Studies that examine disordered eating in samples of Asian individuals living in the United States frequently combine all individuals of Asian descent into a single group, which can obscure important differences between groups and their experiences of acculturation. The goal of the present study was to establish the relation of acculturation, internalization of appearance ideals, and religiosity as predicting body dissatisfaction and disordered eating in women of South and Southeast Asian (SSEA) descent.

Method

Women of SSEA descent (N = 112) aged 18-51 years (M = 23.10, SD = 6.4) completed a battery of questionnaires that inquire about these variables. A path analysis was conducted with acculturation serving as the independent (exogenous) variable, religiosity and internalization of the thin ideal as mediators, and body dissatisfaction and disordered eating as dependent (endogenous) variables.

Results

Direct paths from acculturation to both body dissatisfaction and disordered eating were not significant. Thin ideal internalization completely accounted for the path from acculturation to both endogenous variables; whereas, religiosity did not significantly account for any indirect effect.

Discussion

For SSEA women, internalization of appearance ideals is a potentially greater risk factor for disordered eating than acculturation or religiosity. As this was an atemporal mediation analysis, more work needs to be done exploring predictors of internalization in this population and how that may impact the development of disordered eating.

A complex conceptualization of beauty in Latinx women: A mixed methods study

Latinx women face a myriad of unique pressures to meet unrealistic standards of beauty that are not captured in the dominant, Eurocentric framework of beauty and body image in the U.S. The majority of the extant body image literature represents the experiences of White women and overlooks salient body areas that women of color may experience dissatisfaction with. The present researchers employed a convergent-parallel mixed methods design to examine demographic differences as well as the lived experiences of Latinx women's relationship with beauty and their bodies. Quantitative results from 118 participants revealed that Latinx women with an annual income< 60k (54.2%) reported a higher discrepancy between their actual and ideal buttock size compared to Latinx women with an annual income> 60k (45.8%). Furthermore, a thematic analysis revealed four emergent themes that reflected the unique perceptions and lived experiences of 98 Latinx women's experiences with body image. Findings may assist clinicians working with Latinx women, as they will be able to better understand and integrate relevant cultural aspects of body dissatisfaction when working with Latinx clients.

Body image and internalization of appearance ideals in Black women: An update and call for culturally-sensitive research

Extant research on body image supports sociocultural theories emphasizing the internalization of societal pressures to attain the thin-ideal, as well as other White or Eurocentric ideals that are predominant in mainstream media. While earlier research suggests that Black women are less likely to report body dissatisfaction and thin-ideal internalization compared to women of other racial backgrounds, recent studies argue that most measures of body image and appearance ideals may not be accurate assessments of body dissatisfaction for this population. In this paper, we summarize the literature over the past two decades on body image and appearance ideals among cisgender Black girls and women and discuss the applications of well-established sociocultural theories of body dissatisfaction. We additionally highlight existing gaps in culturally-sensitive theory and assessment tools and consider the benefits of applying intersectionality-informed research. We lastly propose future directions in research, assessment, and intervention to develop more culturally-sensitive approaches to identifying, assessing, and addressing body dissatisfaction among Black girls and women. This paper encourages researchers to apply culturally-sensitive and intersectionality-informed theory to improve efforts in assessing early warning signs of body dissatisfaction and developing effective interventions for this population.

Cross-Country Measurement Invariance and Effects of Sociodemographic Factors on Body Weight and Shape Concern-Related Constructs in Eight Countries

The aim of this study was to examine the cross-country invariance of five well-established measures of body weight and shape concern-related attitudes and behaviors (i.e., drive for leanness, drive for muscularity, strategies to increase muscle, strategies to lose weight, and weight and shape concerns). A secondary objective was to examine the effects of several sociodemographic factors (age, BMI, socioeconomic status, and gender) on item and latent factor scores of these constructs. A total of 6272 emerging adults (4218 women; M_age = 21.46, SD = 3.11) from Australia, Belgium, Canada, China, Italy, Japan, Spain, and the U.S. completed a self-report online survey as part of a larger study. Overall, support for partial invariance both across countries and in terms of the considered sociodemographic factors was found for reduced versions of the five measures. Significant differences in latent means were found across countries, these being of greater magnitude for drive for leanness and strategies to lose weight. The considered sociodemographic factors (most notably BMI and gender) were associated with the latent mean scores of the assessed constructs. The present study contributes to current literature by providing cross-cultural invariant versions of several measures of relevance in the field of body image.