The nature and functions of appearance-related comparisons in body dysmorphic disorder

Appearance-related comparisons (A-RCs) in body dysmorphic disorder (BDD) are under researched despite their probable role in disorder maintenance. The present study therefore aimed to explore the nature (frequency, direction and automaticity), and functions of A-RCs in BDD. N = 43 including people with BDD (n = 23) and controls (n = 20) matched approximately on age and sex were recruited. A mixture of standardized and devised questionnaires on body image and A-RCs were completed. A-RCs were significantly more frequent, generally more upward (to more attractive standards of comparison), and more automatic in people with BDD relative to the control group. People with BDD also held significantly stronger agreement with beliefs about A-RCs as serving functions of: self-evaluation, self-improvement, self-enhancement, and in particular, self-loathing (a way to confirm beliefs about physical unattractiveness) and social threat management. This research presents evidence that the nature and functions of A-RCs in BDD have a role in this disorder's maintenance. Clinical implications, limitations, and future directions for research are discussed.

The interaction between depression diagnosis and BMI is related to altered activation pattern in the right inferior frontal gyrus and anterior cingulate cortex during food anticipation

BACKGROUND

Depression and overweight/obesity often cooccur but the underlying neural mechanisms for this bidirectional link are not well understood.

METHODS

In this functional magnetic resonance imaging study, we scanned 54 individuals diagnosed with depressive disorders (DD) and 48 healthy controls (HC) to examine how diagnostic status moderates the relationship between body mass index (BMI) and brain activation during anticipation and pleasantness rating of food versus nonfood stimuli.

RESULTS

We found a significant BMI-by-diagnosis interaction effect on activation in the right inferior frontal gyrus (RIFG) and anterior cingulate cortex (ACC) during food versus nonfood anticipation (p < .0125). Brain activation in these regions was greater in HC with higher BMI than in HC with lower BMI. Individuals with DD showed an opposite pattern of activation. Structural equation modeling revealed that the relationship between BMI, activation in the RIFG and ACC, and participants' desire to eat food items shown in the experiment depended on the diagnostic status.

CONCLUSIONS

Considering that food anticipation is an important component of appetitive behavior and that the RIFG and ACC are involved in emotion regulation, response inhibition and conflict monitoring necessary to control this behavior, we propose that future clinical trials targeting weight loss in DD should investigate whether adequate mental preparation positively affects subsequent food consumption behaviors in these individuals.

Science mapping research on body image: A bibliometric review of publications in Body Image, 2004-2020

Science mapping is a methodology that combines quantitative analysis, classification, and visualisation to identify the composition and inter-relationships between bibliographic objects. Here, we used bibliometric science mapping to identify the overarching structure, evolution of research themes and research fronts, and geographic spread of body image research. We examined 2,783 keywords in 1,107 articles published in Body Image between 2004 and 2020, selected as being representative of body image research during this period. Co-occurrence analysis of the keywords enabled us to identify five general themes in the literature: "clinical and weight-related issues", "body image and disordered eating", "positive body image and objectification", "media effects", and "ethnicity/race". Burst analysis allowed us to identify research fronts in this research, with work on social media and positive body image in particular being identified as emergent. Finally, co-author analysis indicated that body image research networks are heavily focused on a small handful of nations, although there is evidence of a recent shift toward greater geographic spread. Our results, and the provision of interactive maps and extensive tables, should allow readers to examine connections between research clusters and areas, generate novel research ideas, and more fully understand the evolution and future trajectories of body image research.

Comparisons of Self-Reported and Measured Height and Weight, BMI, and Obesity Prevalence from National Surveys: 1999-2016

OBJECTIVE

The aim of this study was to compare national estimates of self-reported and measured height and weight, BMI, and obesity prevalence among adults from US surveys.

METHODS

Self-reported height and weight data came from the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey, and the Behavioral Risk Factor Surveillance System for the years 1999 to 2016. Measured height and weight data were available from NHANES. BMI was calculated from height and weight; obesity was defined as BMI ≥ 30.

RESULTS

In all three surveys, mean self-reported height was higher than mean measured height in NHANES for both men and women. Mean BMI from self-reported data was lower than mean BMI from measured data across all surveys. For women, mean self-reported weight, BMI, and obesity prevalence in the National Health Interview Survey and Behavioral Risk Factor Surveillance System were lower than self-report in NHANES. The distribution of BMI was narrower for self-reported than for measured data, leading to lower estimates of obesity prevalence.

CONCLUSIONS

Self-reported height, weight, BMI, and obesity prevalence were not identical across the three surveys, particularly for women. Patterns of misreporting of height and weight and their effects on BMI and obesity prevalence are complex.

A Test of Objectification Theory: The Effect of the Male Gaze on Appearance Concerns in College Women

This study extends the research on objectification theory by examining the effect of anticipating a male or female gaze on appearance-related concerns in 105 female undergraduates. Gaze anticipation was manipulated by having participants believe they would be interacting with a man or woman before completing several self-report measures. Results demonstrated that anticipating a male gaze produced significantly greater body shame and social physique anxiety than anticipating a female gaze, while no differences were observed for dietary intent. Discussion centers on the pervasiveness of the experience of self-objectification and the implications of these findings for future research.

Does body mass index moderate the association between posttraumatic stress disorder symptoms and suicidal ideation in Iraq/Afghanistan veterans?

Suicide, PTSD, and obesity co-occur at high rates among returning veterans, yet limited research exists regarding the relationship among these variables. Self-report and diagnostic interview data from a longitudinal study of Iraq and Afghanistan veterans (N=130) enrolled in VA healthcare examined these inter-relations. As hypothesized, body mass index (BMI) significantly moderated the association between PTSD and suicidal ideation such that the association between PTSD and suicidal ideation was strongest among individuals with a high BMI. Programs that focus on health promotion, trauma treatment, and weight management should continue to monitor suicide risk.

Appearance comparison in individuals with body dysmorphic disorder and controls

Research investigating appearance comparison in body dysmorphic disorder (BDD) remains very limited, despite the fact that this is one of the most commonly observed behaviors in individuals with the disorder. The present study investigated the self-reported extent and nature of appearance comparison in 35 BDD participants relative to 45 controls using a newly devised and a standardized appearance comparison measure. The results showed that BDD participants reported significantly higher levels of appearance comparison than controls. Individuals with BDD also reported greater levels of comparing in terms of the specific feature(s) of their appearance they were most concerned about as compared to overall appearance, whilst controls showed the opposite pattern. Levels of comparing in BDD participants increased as targets increased in terms of attractiveness, and individuals with BDD rated themselves as being markedly less attractive than targets, and feeling markedly less satisfied with their appearance after comparing. Cognitive-behavioral treatment implications are discussed.

Painfully thin but locked inside a fatter body: abnormalities in both anticipation and execution of action in anorexia nervosa

Background

People with anorexia nervosa (AN) usually report feeling broader than they really are. The objective of the present study was to better understand the body schema's involvement in this false self-representation in AN. We tested the potential for correction of the body schema impairment via the sensorimotor feedback provided by a real, executed action and relative to an imagined action. We also took account of the impact of the AN patients’ weight variations on the task outcomes.

Methods

Fourteen inpatient participants with AN and fourteen control participants were presented with a doorway-like aperture. The participants had to (i) judge whether or not various apertures were wide enough for them to pass through in a motor imagery task and then (ii) actually perform the action by passing through various apertures.

Results

We observed a higher passability ratio (i.e. the ratio between the critical aperture size and shoulder width) in participants with AN (relative to controls) for both motor imagery and real action. Moreover, the magnitude of the passability ratio was positively correlated with weight recovery.

Conclusion

The body schema alteration in AN appears to be strong enough to affect the patient's actions. Furthermore, the alteration resists correction by the sensorimotor feedback generated during action. This bias is linked to weight variations. The central nervous system might be locked to a false representation of the body that cannot be updated. Moreover, these results prompt us to suggest that emotional burden during weight recovery could also alter sensorimotor aspects of body representation. New therapeutic methods should take account of body schema alterations in AN as adjuncts to psychotherapy.

Psychosocial predictors of body mass index at late childhood: a longitudinal investigation

Little is known about the psychosocial circumstances under which children develop excessive body mass. A community sample was followed up from age 2-10 years to determine which early problems were predictive of increased body mass index. Hypothesized mediators (i.e. eating habits, physical activity, and "screen time") were also examined. After controlling for parental psychopathology, family income, child's gender, and child's body mass index, externalizing behaviors, aggressive behaviors, and anger predicted a relatively high body mass index. Exploratory analyses did not support hypothesized mediators, although low power was an issue.

The relationship between emotional eating and weight problem perception is not a function of body mass index or depression

Weight problem perception (WPP) refers to the belief that one is overweight. Previous research suggests that WPP, even in the absence of actual overweight status, is associated with disordered eating, binge eating, and body image dissatisfaction. However, the relationship between emotional eating, BMI, and WPP has not yet been explored. This investigation recruited a total of 409 college students who completed a web-based survey. An additional 76 participants were recruited to complete an identical survey with the addition of a depression measure to evaluate the contribution of this potentially important covariate. As hypothesized, WPP was associated with emotional eating, while actual BMI was not. In the second sample, WPP remained significantly associated with emotional eating, even after depression was included as a covariate. Results suggest that non-overweight young adults who express the belief that they are overweight may be at risk for emotional eating, which, over the long term, could indeed adversely impact BMI. Cognitive approaches to address disordered eating may benefit from addressing WPP.

Accuracy of self-reported weight and role of gender, body mass index, weight satisfaction, weighing behavior, and physical activity among rural college students

This study measured accuracy of self-reported body mass index (BMI), particularly weight, in a college population. The main purpose was to examine the role of gender, BMI, body weight satisfaction, weighing frequency and physical activity level in accuracy (weight difference, percent weight difference, and absolute weight difference). Students (N=405; 56% female) completed a questionnaire and 325 agreed to have their height and/or weight measured. Gender, BMI and activity level were significantly associated with weight difference and percent weight difference while BMI, activity level and weighing frequency were associated with absolute weight difference. However, interactions between BMI and physical activity were found. Our findings indicate that women and heavier individuals underestimate weight.

Social-evaluative versus self-evaluative appearance concerns in Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) is characterised by significant preoccupation and distress relating to an imagined or slight defect in appearance. Individuals with BDD frequently report marked concerns relating to perceived negative evaluation of their appearance by others, but research specifically investigating such concerns remains limited. This study investigated the extent and nature of appearance-related social-evaluative and self-evaluative concerns in individuals with BDD and healthy controls. BDD participants, in comparison to controls, reported high levels of importance and anxiety associated with perceptions of others' views of their appearance, in addition to their own view. No differences were observed in the level of importance and anxiety associated with their self-view in comparison to others' views. These findings support existing evidence indicating that appearance-related social-evaluative concerns are a central feature of BDD. Cognitive-behavioural treatment implications are discussed.

Accuracy in estimating the body weight of self and others: Impact of dietary restraint and BMI

We examined the accuracy of people's estimates of their own body weight and of the body weight of other people. Female undergraduates (n=132) self-reported their weight, were weighed by the experimenter, and completed a measure of dietary restraint. Participants also viewed 10 photographs of women ranging from underweight to obese and estimated their body weight. Individuals high in dietary restraint underestimated their own weight to a greater extent than those low in dietary restraint, but this effect was accounted for by individual differences in BMI: heavier participants underestimated their weight to a greater extent than leaner participants. Participants also underestimated the weight of heavier targets to a greater extent than they did leaner targets, but the degree of inaccuracy was not related to participants' dietary restraint or BMI. These findings support the hypothesis that inaccuracies in self-reported weight reflect deliberate misreporting rather than a cognitive or perceptual bias.

The Use of Telehealth Technology in Assessing the Accuracy of Self-Reported Weight and the Impact of a Daily Immediate-Feedback Intervention among Obese Employees

Objective. To determine the accuracy of self-reported body weight prior to and following a weight loss intervention including daily self-weighing among obese employees. Methods. As part of a 6-month randomized controlled trial including a no-treatment control group, an intervention group received a series of coaching calls, daily self-weighing, and interactive telemonitoring. The primary outcome variable was the absolute discrepancy between self-reported and measured body weight at baseline and at 6 months. We used general linear mixed model regression to estimate changes and differences between study groups over time. Results. At baseline, study participants underreported their weight by an average of 2.06 (se = 0.33) lbs. The intervention group self-reported a smaller absolute body weight discrepancy at followup than the control group. Conclusions. The discrepancy between self-reported and measured body weight appears to be relatively small, may be improved through daily self-monitoring using immediate-feedback telehealth technology, and negligibly impacts change in body weight.

The relationship between binge eating and weight status on depression, anxiety, and body image among a diverse college sample: a focus on Bi/Multiracial women

Binge eating is associated with a host of adverse outcomes, but little is known about sex and racial differences among those who binge eat. The present study examined sex and racial group differences in binge eating based on weight status within a college-student population. It was hypothesized that White women would endorse higher rates of binge eating, depression, anxiety, and body image dissatisfaction than other groups. Participants completed a web-based survey assessing depression, anxiety, body image, weight history, physical activity, smoking, and body mass index. Participants included White, Black, and Bi/Multiracial college students. Findings highlighted sex and racial differences based on binge eating and weight status. Notably, Bi/Multiracial women who endorsed binge eating behavior and who were overweight reported greater levels of anxiety than all other groups and greater levels of depression than White women and White men. Additionally, Bi/Multiracial women and White women who endorsed binge eating behavior and who were overweight reported greater body image dissatisfaction relative to Black women and White men. Future research should further explore the nature and impact of sex and race differences on binge eating.

Protective self-presentation style: association with disordered eating and anorexia nervosa mediated by sociocultural attitudes towards appearance

OBJECTIVE

We tested the hypothesis that a protective self-presentation style (Lennox and Wolfe, 1984) is associated with eating pathology and anorexia nervosa (AN) and that this association is mediated by sociocultural attitudes towards appearance emphasizing the thin ideal.

METHOD

We compared the protective-presentation style of women with AN (N=17), partially recovered women (N=110), fully recovered women (N=73), and female controls (N=374).

RESULTS

Ill women had a more protective self-presentation style than partially or fully recovered women, who in turn had a more protective self-presentation style than controls. Sociocultural attitudes towards appearance fully mediated the association between protective self-presentation and disordered eating.

CONCLUSIONS

Protective self-presentation may therefore be a risk factor for AN and/or a prognostic factor. Implications for therapy and prevention are discussed.

The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students

College student participants (N=1063; 77.8% response rate) completed a web-based survey assessing demographics, depression, anxiety, body image, cigarette smoking, and weight history. Among overweight participants, 42.6% of those who believed they were overweight admitted to binge eating, while only 30.1% who did not feel overweight did so (p<.05). Among non-overweight participants, 43.2% of those who believed they were overweight admitted to binge eating, while only 32.9% of those who did not feel overweight did so (p<.05). Weight Problem Perception (WPP) mediated the contribution of BMI on binge eating outcomes, and WPP contributed significantly to the prediction of binge eating, beyond the risk conferred by established correlates of binge eating (e.g., gender, mood, and cigarette smoking). Results suggest that when assessing risk for binge eating, a one-question assessment of whether or not an individual believes s/he is overweight has significant predictive power. Findings are consistent with literature on the importance of the "fat self-schema" [Stein, K.F., & Corte, C. (2007). Identity impairment and the eating disorders: Content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 15 (1), 58-69] in disordered eating and theory implicating identity in the maintenance of addictive behavior [West, R.W. (2006). Theory of Addiction. Malden, MA: Blackwell Publishing, Inc.].

Associations between body mass index and substance use disorders differ by gender: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol, illicit drugs, and nicotine can affect appetite and body weight, but few epidemiologic studies have examined relationships between body mass index (BMI) and substance use disorders. This study used logistic regression to examine effects of BMI and gender on risk for DSM-IV substance use disorders in a sample of 40 364 adults. Overweight and obesity were associated with increased risk for lifetime alcohol abuse and dependence in men but not women. Overweight and obesity were associated with decreased risk for past-year alcohol abuse in women. BMI was not associated with illicit drug use disorders. Overweight and obese men were at decreased risk for both lifetime and past-year nicotine dependence. Overweight women were at increased risk for lifetime nicotine dependence, and obese women were at decreased risk for past-year nicotine dependence. Further research is needed to identify reasons for observed gender differences in relationships between BMI and substance use disorders.

Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

This study evaluated associations between body mass index (BMI) and psychiatric disorders.

METHODS

Data from 41,654 respondents in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed.

RESULTS

After controlling for demographics, the continuous variable of BMI was significantly associated with most mood, anxiety, and personality disorders. When persons were classified into BMI categories of underweight, normal weight, overweight, obese, and extremely obese, both obese categories had significantly increased odds of any mood, anxiety, and alcohol use disorder, as well as any personality disorder, with odds ratios (ORs) ranging from 1.21 to 2.08. Specific Diagnostic and Statistical Manual of Mental Disorders-revision IV mood and personality disorders associated with obesity included major depression, dysthmia, and manic episode (ORs, 1.45-2.70) and antisocial, avoidant, schizoid, paranoid, and obsessive-compulsive personality disorders (ORs, 1.31-2.55). Compared with normal weight individuals, being moderately overweight was significantly associated with anxiety and some substance use disorders, but not mood or personality disorders. Specific anxiety disorders that occurred at significantly higher rates among all categories of persons exceeding normal weight were generalized anxiety, panic without agoraphobia, and specific phobia (ORs, 1.23-2.60). Being underweight was significantly related to only a few disorders; it was positively related to specific phobia (OR, 1.31) and manic episode (OR, 1.83), and negatively associated with social phobia (OR, 0.60), panic disorder with agoraphobia (OR, 0.40), and avoidant personality disorder (OR, 0.59).

CONCLUSION

These data provide a systematic and comprehensive assessment of the association between body weight and psychiatric conditions. Interventions addressing weight loss may benefit from integrating treatment for psychiatric disorders.

Gender differences in associations between body mass index and DSM-IV mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

PURPOSE

The purpose of this study is to examine gender differences in associations between body mass index (BMI) and affective disorders.

METHODS

We used logistic regression to examine the effects of BMI and gender on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood and anxiety disorders in a sample of 40,790 adults.

RESULTS

Obesity (BMI >30.0) was associated with increased risk for any mood disorder, major depressive disorder, and dysthymic disorder, in both men and women (odds ratios [ORs], 1.35-1.88). Risk of bipolar I and II disorders was elevated in obese women (ORs, 1.70-2.41) but not men. Overweight (BMI = 25.0-29.9) predicted increased risk for any mood disorder and bipolar I disorder in women but not in men (ORs, 1.16-1.44). Obesity was associated with increased odds of any anxiety disorder and specific phobia in men and women (ORs, 1.35-1.79). Obese women were additionally at increased risk for social phobia. Overweight predicted increased risk of social phobia and specific phobia for women but not for men (ORs, 1.27-1.37).

CONCLUSIONS

Obese individuals of both genders are at increased risk for a range of mood and anxiety disorders, but women who are even moderately overweight experience increased risks for some disorders as well.

Measurement Invariance of the Appearance Schemas Inventory–Revised and the Body Image Quality of Life Inventory Across Age and Gender

The majority of body image measures have largely been developed with younger female samples. Before these measures can be applied to men, and to middle-aged and older women, and used to make gender and age comparisons, they must exhibit adequate cross-group measurement invariance. This study examined the age and gender cross-group measurement invariance of the Appearance Schemas Inventory—Revised (ASI-R) and the Body Image Quality of Life Inventory (BIQLI), with a sample of 1,262 adults (422 men and 840 women) aged 18 to 98 years. For the ASI-R, all groups met requirements for configural and metric invariance. Scalar invariance was found only for the three age groups, which indicated that mean comparisons may be conducted across gender for young, middle-aged, and older adults but should not be conducted across age groups within either gender. Results for the BIQLI indicated that observed mean comparisons may be conducted across all age and gender groups.

Anorexia nervosa, perfectionism, and dopamine D4 receptor (DRD4)

The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candidate for contributing risk to disordered eating and anorexia nervosa (AN). We tested association using UNPHASED for 5 DRD4 polymorphic loci, 3 promoter region SNPs (C-521T, C-616G, A-809G), the 120 bp promoter region tandem duplication and the exon III repeat, in 202 AN trios and 418 control families. Since perfectionism characterizes AN, we tested these five loci for association with the Child and Adolescent Perfectionism Scale (CAPS) in the AN and control groups. Single locus analysis showed significant association between the 'C' C-521T allele and AN. Haplotype analysis also showed significant association, particularly a 4-locus haplotype (exon III&120 bp repeat&C-521T&A-809G). Association was also observed between DRD4 and CAPS scores both for AN and control subjects. The insulin-like growth factor 2 (IGF2) and the arginine vasopressin 1a receptor (AVPR1a), previously shown to be associated with disordered eating, were also associated with CAPS scores. Three genes associated with AN were also associated with perfectionism. Personality traits are potential endophenotypes for understanding the etiology of eating disorders and one of the several pathways to eating pathology may be mediated by the impact of DNA sequences on perfectionism.

Weight overestimation as an indicator of disordered eating behaviors among young women in the United States

OBJECTIVE

This paper examines the association between weight overestimation and symptoms of disordered eating behaviors using a nationally representative sample of young women.

METHOD

We use data from Wave III of the National Longitudinal Study of Adolescent Health to compare self-reported weight (in pounds) to measure weight obtained by interviewers using a scale. Focusing on normal weight women between the ages of 18 and 24 (n = 2,805) we compare the discrepancy in self-reported and measured weight among women with and without any disordered eating behaviors.

RESULTS

Women who over report their weight by at least five percent are significantly more likely than those who either under report or accurately report their weights to exhibit disordered eating behaviors. These results persist despite controlling for distorted body image.

CONCLUSION

Our findings support both motivational and perceptual bias explanations for overestimating weight among those who exhibit disordered eating behaviors. We argue that weight over-estimation, together with other important information regarding women's nutrition, exercise, mental health, and health-related behaviors, should be treated as a potential indicator for the diagnosis of an eating disorder among young normal weight women.

A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review

Obesity is a rapidly increasing public health problem, with surveillance most often based on self-reported values of height and weight. We conducted a systematic review to determine what empirical evidence exists regarding the agreement between objective (measured) and subjective (reported) measures in assessing height, weight and body mass index (BMI). Five electronic databases were searched to identify observational and experimental studies on adult populations over the age of 18. Searching identified 64 citations that met the eligibility criteria and examined the relationship between self-reported and directly measured height or weight. Overall, the data show trends of under-reporting for weight and BMI and over-reporting for height, although the degree of the trend varies for men and women and the characteristics of the population being examined. Standard deviations were large indicating that there is a great deal of individual variability in reporting of results. Combining the results quantitatively was not possible because of the poor reporting of outcomes of interest. Accurate estimation of these variables is important as data from population studies such as those included in this review are often used to generate regional and national estimates of overweight and obesity and are in turn used by decision makers to allocate resources and set priorities in health.

Media-portrayed idealized images, self-objectification, and eating behavior

This study examined the effects of media-portrayed idealized images on young women's eating behavior. The study compared the effects for high and low self-objectifiers. 72 female university students participated in this experiment. Six magazine advertisements featuring idealized female models were used as the experimental stimuli, and the same six advertisements with the idealized body digitally removed became the control stimuli. Eating behavior was examined using a classic taste test that involved both sweet and savory food. Participants' restraint status was assessed. We found that total food intake after exposure was the same in the body present and absent conditions. There were also no differences between high and low self-objectifiers' total food intake. However, for the total amount of food consumed and for sweet food there were significant group by condition interaction effects. High self-objectifiers ate more food in the body present than the body absent condition. In contrast, low self-objectifiers ate more food in the body absent than in the body present condition. Restraint status was not found to moderate the relationship between exposure to idealized images the amount of food consumed. Our results indicate that exposure to media-portrayed idealized images can lead to changes in eating behavior and highlight the complexity of the association between idealized image exposure and eating behavior. These results are discussed in terms of their implications for the prevention of dieting-related disorders.

An examination of cognitive versus behavioral components of recovery from anorexia nervosa

Definitions of "full recovery" from anorexia nervosa (AN) vary, and rarely include the cognitive criteria of lack of body image distortion and fear of weight gain. We investigated the implications of including or excluding cognitive criteria of AN in the definition of "full recovery". Current symptomatology and personality characteristics associated with AN were assessed and compared in 42 behaviorally but not cognitively recovered women, 32 both behaviorally and cognitively recovered women, and 253 controls. On all measures included, the scores of the behaviorally recovered women were significantly more anorexic-like than those of the women recovered cognitively as well, who were indistinguishable from controls. Criteria for recovery from AN need to be refined and standardized, and cognitive criteria incorporated, to characterize a minority who recover to the extent that their eating attitudes and personality profiles are indistinguishable from those of women with no history of an eating disorder.

How Anorexic-like Are the Symptom and Personality Profiles of Aesthetic Athletes?

PURPOSE

We tested the hypothesis that aesthetic athletes (AA) have anorexic-like eating attitudes and behaviors, share personality characteristics such as perfectionism and obsessiveness, and are at high risk of eating disorders.

METHODS

We compared symptomatology, personality variables typical of anorexia nervosa, and lifetime eating disorder prevalence across four groups of Israeli women: 31 anorexics, 111 AA (mostly dancers), 68 nonaesthetic athletes (NAA), and 248 controls. All participants completed self-report measures of symptomatology, harm avoidance, perfectionism, obsessiveness, self-esteem, and self-rated facial attractiveness and were screened for eating disorders. Those screening positively were interviewed and diagnosed using the structured clinical interview for DSM-IV.

RESULTS

Scores of the anorexic women differed from those of the three other groups in the expected direction on all variables. NAA scored similarly to controls, but had greater body satisfaction and less drive for thinness. Surprisingly, the AA did not differ from control women on any self-report measure. However, significantly more AA (11.7%) than NAA (5.8%) and controls (4.4%) had a lifetime diagnosis of eating disorder not otherwise specified (EDNOS). The eating attitudes and behavior of the 13 AA with a lifetime history of EDNOS fell intermediately between the anorexic women and the controls, whereas their personality profile resembled that of controls.

CONCLUSIONS

Being a nonaesthetic female athlete in Israel appears to promote body esteem and offer some protection from a preoccupation with dieting. AA also appear to enjoy excellent psychological health; however, a subgroup has EDNOS and appears not to receive appropriate treatment for it. These results lend credibility to the existence of the diagnostic entity of anorexia athletica, proposed to be a subclinical, environmentally influenced eating disorder with a favorable prognosis.

Accuracy of reported weight and menstrual status in teenage girls with eating disorders

OBJECTIVE

The current study investigated the accuracy of reported current and historical weights and of menstrual status in teenage girls with eating disorders.

METHOD

Reported current weight in one interview was compared with measured weight at another occasion. Reported historical weights were compared with documented weights from growth charts of the school health services. Reports of menstrual status from two different interviews were compared.

RESULTS

The overall correlation between reported and measured/documented weight was high. Current weight was reported with high accuracy in all diagnostic groups and without tendencies to underreport. Patients with bulimia nervosa, but not those with anorexia nervosa, underreported their historical top weight. The most common reason for large discrepancies between reported and documented historical weights was that the two weights compared referred to different time points. The reports on menstrual status were divergent for 13% of the patients, most notably 4 of 15 patients on oral contraceptives had been categorized as having menstruations in one of the interviews.

CONCLUSION

Reported weight history and menstrual status are of high accuracy in teenage girls with eating disorders.

Parents' reports of the body shape and feeding habits of 36-month-old children: an investigation of gender differences

OBJECTIVE

The current study examined parental perception of offspring body shape, differential reporting of offspring eating behaviors by mothers and fathers, and gender-specific patterns of offspring feeding habits.

METHODS

Parents of a community sample of 36-month-old children (N = 93) completed measures regarding their offspring's feeding patterns and body shape.

RESULTS

Results revealed noteworthy correlates (e.g., concerns about their child's appetite) of parental perception of offspring weight status. They further suggested that mothers and fathers often differed in their accounts of their child's eating habits, and that parents report certain eating behaviors differently depending on the gender of their child.

CONCLUSION

Clinical and theoretical implications are discussed.

Accuracy in the estimation of body weight: an alternate test of the motivated-distortion hypothesis

OBJECTIVE

Inaccuracies in self-reported weight are believed to represent a motivated distortion, but cognitive or perceptual biases have not been excluded. We examined the ability of participants to estimate the weight of a target person as a means of distinguishing between motivated distortions and perceptual biases.

METHOD

Participants (restrained eaters and unrestrained eaters; women and men) estimated the weight of a target individual, which was compared with the actual weight of the target individual.

RESULTS

Restrained and unrestrained eaters did not differ in their estimates of the target's weight, and men underestimated the target's weight to a greater extent than did women.

DISCUSSION

The pattern of inaccuracies observed does not parallel those found in research on self-reported weight. This observation suggests that perceptual biases do not explain inaccuracies in self-reported weight and that such inaccuracies may be the result of motivated distortions. Issues regarding data analysis and presentation are also discussed.

Accuracy of self-reported height and weight in women: an integrative review of the literature

Height and weight are two of the most commonly used anthropometric measurements in clinical practice and research. Self-reported height and weight measurement is a simple, efficient, inexpensive, and non-invasive method of collecting data from large numbers of people. This integrative review of the published research examined the accuracy of self-reported height and weight measurements in women. Twenty-six studies examined the accuracy of self-reported height in 39,244 women. Twenty-one of the studies found that women overestimate height. Thirty-four studies reviewed the accuracy of self-reported weight in 57,172 women, and all 34 studies reported that women underestimated weight. Although mean variations between self-reported and measured values were small, a significant percentage of women in study groups had very large errors. Inaccurate measurements of both height and weight can cause significant inaccuracies in calculation of body mass index, which is used as a guide for identifying persons at risk for disease. These findings indicate that direct measurement of height and weight should be performed whenever possible for optimal measurements in clinical practice and clinically oriented research.

The effects of restraint, gender, and body mass index on the accuracy of self-reported weight

OBJECTIVE

Previous research has shown that women, restrained eaters, and overweight/obese individuals have a tendency to underreport their weight. This study investigated gender, dietary restraint, and BMI to determine which is the best predictor of errors in self-reported weight.

METHOD

A total of 241 college students completed questionnaires pertaining to height and weight and then were weighed in the laboratory.

RESULTS

Although overall students were fairly accurate in reporting their weight, restraint status was the best predictor of weight underestimation.

DISCUSSION

These results suggest that restrained eaters, regardless of gender or BMI, have a tendency to underestimate their weight.

The accuracy of self-reported weight by overweight and obese women in an outpatient setting

OBJECTIVE

To investigate the accuracy of self-reported weight of overweight and obese women and characterisation of under-, correct- and over-reporters based on a number of related variables.

DESIGN

Weight was self-reported before entering the study. At baseline, actual weight was recorded, and demographic, health, nutritional, psychological and physical activity questionnaires were completed.

SETTING

A hospital outpatient department.

SUBJECTS

Participants were 131 women aged 18-64 years with a body mass index attending a Comprehensive Weight Management Programme.

OUTCOME MEASURES

The accuracy of self-reported weight was investigated for the total group, and the subjects were then categorised into three groups according to accuracy of self-reported weight (under-, correct- and over-reporters). The relationship between these accuracy groups and demographic, health, nutritional, and psychological variables and physical activity was examined, to characterise the under-, correct- and over-reporters.

RESULTS

Although not statistically significantly different, the total group of women tended to underestimate their weight by 0.8 (+/-3.6) kg. Categorisation according to the accuracy groups revealed that 29% underestimated their weight by 2 kg or more, 19% overestimated their weight by 2 kg or more, and only 52% correctly estimated their weight within 2 kg. Some trends and statistically significant differences between the accuracy groups concerning certain variables, e.g. height, age, income, education, contraceptive pill usage, smoking and food choices were evident.

CONCLUSIONS

Self-reported weight of a group of overweight/obese individuals may be a valid and reliable indicator of actual weight, but self-reported weight of an overweight/obese individual can not be interpreted similarly. Further research is necessary to ensure reliable characterisation of under-, over- and correct reporters.

Eating disorders, dieting, and the accuracy of self-reported weight

OBJECTIVE

This study investigated the accuracy of self-reported weight and height in individuals with an eating disorder (i.e., anorexia nervosa [AN] and bulimia nervosa [BN]) and in individuals without an eating disorder (i.e., dieters and nondieters).

METHOD

Self-reported and measured weights and heights were obtained from the eating disorder sample (n = 81) and the college student sample (n = 163) and were compared within and between the groups.

RESULTS

Eating disorder patients were extremely accurate at self-reporting their weight. However, there was a significant difference in accuracy between AN and BN patients. AN patients slightly overreported their weight, whereas BN patients slightly underreported their weight. Both dieters and nondieters significantly underreported their weight. However, dieters significantly underreported their weight to a greater degree than did the nondieters.

DISCUSSION

The implications of these subgroup differences and their specificity to weight reporting are discussed with reference to the accuracy of self-reported height.

Accuracy of self-reported weight in patients with binge eating disorder

OBJECTIVE

This study was designed to evaluate the accuracy of self-reported weight in patients with binge eating disorder.

METHOD

Subjects were 108 adults who were consecutively evaluated for outpatient clinical trials and met DSM-IV criteria for binge eating disorder. Self-reported and measured weights were taken and participants were administered a battery of measures to examine correlates of reporting error. In addition, accurate reporters of weight (i.e., individuals who reported their weight within 5 lb of their measured weight) were compared to underreporters (i.e., individuals who underreported their weight by more than 5 lb) on eating disorder psychopathology and conceptually related measures.

RESULTS

Overall, most binge eating disorder subjects were accurate in reporting weight: 73% were accurate within 5 lb and 82% were accurate within 10 lb. Self-reported and measured body mass index were highly correlated and the magnitude of the difference was nonsignificant. Body mass index was not significantly associated with the degree of accuracy, that is, accurate reporters weighed about the same as underreporters. Accurate reporters and underreporters did not differ on measures of overeating behaviors, eating disorder psychopathology, and conceptually related measures.

DISCUSSION

These findings suggest that most patients with binge eating disorder were accurate in self-reporting weight. Unlike findings in healthy samples, heavier patients with binge eating disorder were not more likely to underreport weight. Similar to findings in patients with bulimia nervosa, eating disorder psychopathology was not related to reporting error.

Discrepancy between actual and ideal body images; Impact on eating and exercise behaviors

This study examined how discrepancies between actual and ideal body images are related to eating and exercise patterns. A total of 115 college-age women completed the Body Discrepancy Scale (BDS, a measure of the discrepancy between one's "actual" vs. "ideal" weight and size), a leisure-time physical activity survey, and questionnaires assessing the intake of fat and fiber (i.e., fruits and vegetables), as well as measures of maladaptive eating attitudes and behaviors. Partial correlations (controlling for Body Mass Index, BMI) showed that scores on the BDS were significantly (P's<.05) associated with low levels of physical activity (r=-.28), with low levels of fruit and vegetable consumption (r=-.19), and with high levels of body image dissatisfaction (r=.32) and binge eating (r=.32). Collectively, these findings suggest that discrepancies between actual and ideal body images are associated with maladaptive eating and exercise patterns.

Are inaccuracies in self-reported weight motivated distortions?

The accuracy of self-reported weight and the motivation of distorted reporting were studied among 169 female and 101 male college students. Although subjects were moderately accurate in their weight estimates, errors reflected women's underreporting, men's overreporting, and heavier persons' underreporting. With body mass controlled, most motivational variables had little explanatory value.

Accuracy of self-reported weight: covariation with binger or restrainer status and eating disorder symptomatology

Studies indicate that women's self-reported and actual weights correlate above .90 but that approximately one-third of women under-report their weight by more than 5 lb. Overweight women under-report to a greater degree than women of normal weight. The present study replicated these findings and extended them to women showing eating disorder-related behaviors, including regular binging and dietary restraint. Reporting accuracy was also covaried with eating disorder tendencies as measured on a continuum in the general population. Despite high statistical power, results revealed no correlation between under-reporting and either Bulimia Test scores or Eating Attitudes Test scores and found no differences in reporting accuracy as a function of binger status or restrained eater status. Women manifesting eating disorder-relating behaviors were neither more nor less accurate than were normals. Potential sources of error in measuring weight and in evaluating self-report are presented and discussed.