"They are men, they will be looking even if you put on pants or a sweatshirt": Girl athletes' and coaches' experiences of body image in Mexico City sport settings

Body image concerns are a barrier for girls' participation in sports. Scarce evidence from Mexico suggests adolescents experience high levels of body dissatisfaction, and national statistics report low levels of physical activity among girls. This study aimed to explore girls' body image concerns and coaches' perceptions of girls' body image experiences in sport. We used reflexive thematic analysis on secondary data from semi-structured focus groups conducted in Mexico City with 12 girls aged 11-17 years and six coaches from two sports organizations. Girls expressed feelings of self-consciousness about their performance, body-related teasing, the male gaze, and harassment within and outside sports contexts. Lack of support from coaches resulted in making excuses for withdrawing or supporting one another. Coaches' accounts demonstrate gender stereotypes about girls in sport. They acknowledge that girls abandon sport because of appearance-related teasing and body image concerns. In addition, colorism and discomfort with speaking directly about bodily functions are fundamental sociocultural influences affecting their communication. This is the first qualitative study exploring girls' body image concerns and coaches' perceptions of such concerns in Mexico City. Further research in lower- and middle-income countries is key in developing effective intervention programs to help girls benefit from sport.

A six-country study of coaches' perspectives of girls' body image concerns in sport and intervention preferences: Template analysis of survey and focus group data

Coaches are a key influence of athletes' body image, but often feel ill-equipped to address body image concerns and can perpetuate harmful body ideals. Limited research has investigated coaches' attitudes and beliefs and few effective resources are available. The current study explored coaches' perspectives of body image among girls in sport, as well as their preferences for body image interventions. Thirty-four coaches (41% women; Mage=31.6 yrs; SD=10.5) from France, India, Japan, Mexico, the United Kingdom, and the United States took part in semi-structured focus groups and completed an online survey. Template analysis of survey and focus group data resulted in eight first-order themes grouped under three categories: (1) perspectives of body image among girls in sport (objectification and surveillance, impact of puberty, the role of the coach); (2) preferences for intervention design (content of the intervention, accessibility of the intervention, incentives for taking part); and (3) cross-cultural considerations (acknowledging your privilege, cultural and societal norms). Two integrative themes were defined: (1) girls' disengagement from sport and (2) the role of community. Coaches perceived body image to be a significant barrier for girls in sport and a need to address this in a formal and accessible intervention.

How can we help you? A global investigation into girls' body image experiences in sport and intervention preferences

Existing interventions that target the intersection of girls' body image and sports participation are marginally effective, which is, in part, due to methodological limitations pertaining to intervention development (i.e., not theoretically or stakeholder informed). In this research, girls were consulted on their positive and negative body image experiences in sport and their preferences for fostering and remedying these experiences, respectively, in a new intervention. One-hundred and two girls (11-17-years; n = 91) and youth advisory board members (18-35-years; n = 15) from 13 countries participated in semi-structured focus groups and/or surveys. Template analysis of focus group and survey data resulted in 10 first-level themes and three integrative themes, which highlighted factors that both hinder and help girls' body image while playing sport, as well as girls' intervention preferences and cross-national considerations that will eventually impact the adaptation, localisation, and scaling of the intervention. Overall, girls favoured a girl and woman-only, multimodal intervention that upskilled them in appreciating their bodies, while challenging others' harmful behaviours. Stakeholder insights are crucial in creating acceptable, effective, and scalable interventions. Insights from this consultation phase will inform the development of a new scalable, evidence- and stakeholder-informed intervention that aims to foster girls' positive body image and sports enjoyment.

The co-creation, initial piloting, and protocol for a cluster randomised controlled trial of a coach-led positive body image intervention for girls in sport

BACKGROUND

Globally, girls disengage from sports at an earlier age and higher rate than boys. This is, in part, due to the unique body image challenges that girls face, relative to their male peers. Existing intervention efforts that aim to reduce girls' negative body image and movement experiences have proven marginally effective, if not ineffective. This paper outlines the co-creation, initial piloting and protocol for a cluster randomised controlled trial of Body Confident Athletes (BCA); an in-person, coach-led intervention that aims to foster positive body image and sports enjoyment among girls.

METHODS

Following co-creation and an initial pilot, a two-armed cluster randomised controlled trial will assess the immediate (post-intervention) and short-term (1-month and 3-month follow-up) impact of BCA on girls' (N = 1,036; 11-17 years old) body image, sports enjoyment, and affect. Sport organisations will be randomly allocated (1:1) into either an intervention or waitlist control condition. Girls and coaches in the intervention condition will complete three 60-minute sessions over three consecutive weeks. The primary outcome will be the immediate change in girls' body esteem, with secondary outcomes assessing the immediate and short-term changes in girls' body appreciation, self-objectification, attuned self-care, sports enjoyment, and affect.

DISCUSSION

This research is the first to utilise an international multi-stakeholder partnership to co-create and evaluate an intervention that addresses the intersection of girls' body image and sport experiences. The theoretical and methodological considerations of this research have led to a feasible intervention and trial protocol, and if proven effective, BCA may assist in reducing the global gender disparity in sports participation.

TRIAL REGISTRATION NUMBER

NCT05594524 , registered 25^th October 2022.

Development and preliminary validation of the Coach Self-Efficacy Body Image Scale (CSEBIS)

Body image concerns are a commonly cited reason for sport drop out. Researchers have begun to explore the influence of coaches on athletes' body image. However, no measure exists to accurately and easily assess interventions or predict coaches' body image supportive behaviors. Using Self-Efficacy Theory as a conceptual framework, the Coach Self-Efficacy Body Image Scale (CSEBIS) was developed. Content validity was judged by a panel of experts (N = 3) and through interviews with coaches (N = 4) across various sports and experience levels. Following initial item iteration, the CSEBIS was assessed with 682 coaches for reliability and validity. The 27 items across four subscales (knowledge, recognition, engagement, disengagement) showed good reliability (internal consistency, test-retest reliability, inter-item and item-total correlations), validity (convergent and discriminant validity, differentiation between known groups), factor structure, and model invariance across gender. Developing and initially validating the CSEBIS contributes to the existing literature by providing researchers with a novel scale to measure coaches' confidence in identifying and addressing body image concerns among their athletes. Following further testing, this instrument may be used to assess the effectiveness of body image education and intervention efforts in sport, and the impact of coaches' attitudes and behaviors on athletes' body image.

A mixed-studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID-19 pandemic

OBJECTIVES

This systematic review assessed the influence of the COVID-19 pandemic and associated restrictions on body image, disordered eating (DE), and eating disorder outcomes.

METHODS

After registration on PROSPERO, a search was conducted for papers published between December 1, 2019 and August 1, 2021, using the databases PsycINFO, PsycARTICLES, CINAHL Plus, AMED, MEDLINE, ERIC, EMBASE, Wiley, and ProQuest (dissertations and theses).

RESULTS

Data from 75 qualitative, quantitative, and mixed-methods studies were synthesized using a convergent integrated approach and presented narratively within four themes: (1) disruptions due to the COVID-19 pandemic; (2) variability in the improvement or exacerbation of symptoms; (3) factors associated with body image and DE outcomes; (4) unique challenges for marginalized and underrepresented groups. Disruptions due to the pandemic included social and functional restrictions. Although most studies reported a worsening of concerns, some participants also reported symptom improvement or no change as a result of the pandemic. Factors associated with worse outcomes included psychological, individual, social, and eating disorder-related variables. Individuals identifying as LGBTQ+ reported unique concerns during COVID-19.

DISCUSSION

There is large variability in individuals' responses to COVID-19 and limited research exploring the effect of the pandemic on body image, DE, and eating disorder outcomes using longitudinal and experimental study designs. In addition, further research is required to investigate the effect of the COVID-19 pandemic on body image and eating concerns among minoritized, racialized, underrepresented, or otherwise marginalized participants. Based on the findings of this review, we make recommendations for individuals, researchers, clinicians, and public health messaging.

PUBLIC SIGNIFICANCE

This review of 75 studies highlights the widespread negative impacts that the COVID-19 pandemic and associated restrictions have had on body image and disordered eating outcomes. It also identifies considerable variations in both the improvement and exacerbation of said outcomes that individuals, researchers, clinicians, and other public health professionals should be mindful of if we are to ensure that vulnerable people get the tailored support they require.

The effects of patient sex and race on medical students' ratings of quality of life

PURPOSE

Although previous studies have examined race and sex differences in health care, few studies have investigated the possible role of physician bias. We evaluated the influence of race and sex on medical students' perceptions of patients' symptoms to determine if there are differences in these perceptions early in medical training.

SUBJECTS AND METHODS

One-hundred sixty-four medical students were randomly assigned to view a video of a black female or white male actor portraying patients with identical symptoms of angina. We evaluated students' perceptions of the actors' health state (based on their assessment of quality of life) using a visual analog scale and a standard rating technique, as well as the type of chest pain diagnosis.

RESULTS

Students assigned a lower value (indicating a less desirable health state) to the black woman than to the white man with identical symptoms [visual scale (mean +/- SD): 72 +/- 13 vs 67 +/- 12, P <0.02; standard gamble: 87 +/- 10 vs 80 +/- 15, P < 0.001). Nonminority students reported higher mean values for the white male patient (standard gamble: 89 +/- 8 vs 81 +/- 14 for the black female patient), whereas minority students' assessments did not differ by patient. Male students assigned a slightly lower value to the black female patient (standard gamble: 76 +/- 16 vs 87 +/- 10 for the white male patient). Students were less likely to characterize the black female patient's symptoms as angina (46% vs 74% for the white male patient, P = 0.001).

CONCLUSIONS

The way that medical students perceive patient symptoms appears to be affected by nonmedical factors.

Laparoscopic choledochoduodenostomy

Laparoscopic cholecystectomy is nowadays a well-established procedure in the management of gallbladder lithiasis. The sutures used in the past only for open surgery are progressively being introduced to laparoscopic procedures. The authors describe 25 cases of choledochoduodenostomy using the laparoscopic route. In 19 patients with choledocholithiasis and a common bile duct of > or = 2 cm, and in 6 cases of obstructive jaundice secondary to advanced unresectable pancreatic neoplasms, the technique produced good results as a permanent solution to the life-threatening problem of common bile duct obstruction. Manual anastomosis and intracorporeal knotting were easily performed and proved to be a safe technique in such cases.