The effectiveness of a masked counterconditioning approach using continuous flash suppression to alleviate body dissatisfaction in women with high body image concerns

BACKGROUND AND OBJECTIVES

Research that used counterconditioning (CC) to reduce women's negative body image has led to mixed results. One explanation could be that the negative responses elicited by own body pictures hinder the effectiveness of CC procedures in adjusting overly negative attitudes towards the own body. In this study we therefore tried to prevent the impact of negative responses by limiting women's perceptual awareness of the own body pictures during the CC procedure.

METHODS

Women with a negative body image were randomly assigned to an experimental (n = 75) or control (n = 71) condition. In the experimental condition, participants' masked body pictures were systematically followed by visible social approval cues (i.e., smiling faces), whereas neutral body-unrelated control pictures were followed by a blank screen. In the control condition, both own body and control pictures were followed by a blank screen.

RESULTS

Participants in the experimental condition did not report a more positive evaluation of the own body (pictures) after CC than participants in the control condition. Also, the strength of automatic affective body evaluations as indexed by a single-target Implicit Association Test did not differ between conditions.

LIMITATIONS

Many participants did not remain fully unaware of their body pictures during conditioning.

CONCLUSIONS

The findings provided no support for the idea that CC with masked own body pictures can be used in women with body dissatisfaction to improve their body image.

Mindfulness-based interventions for body image dissatisfaction among clinical population: A systematic review and meta-analysis

PURPOSE

Mindfulness-based interventions (MBIs) are well-validated interventions to enhance the favourable body image of individuals. Despite their wide application, the efficacy of MBIs in reducing body image dissatisfaction (BID) among various clinical populations remains unclear. This study aims to expand the literature on MBIs for BID and identify effective types of MBIs for reducing BID in diverse clinical populations for future research and practice.

METHODS

A systematic search for studies published in English on the effectiveness of MBIs for BID among the clinical population was done on APA PsycNet, PubMed, Science Direct, Web of Science and Google Scholar databases in August 2023. Of the 1962 articles initially identified, 17 were found eligible and evaluated based on the JBI checklist.

RESULTS

Random effects meta-analyses on six MBIs revealed their effectiveness in reducing BID among the clinical population (SMD = -.59 and 95% CI = -1.03 to -.15, p = .009), with Acceptance and Commitment Therapy (ACT) (SMD = -1.29, 95% CI = -2.06 to -.52, p = .001) and My Changed Body (MyCB) (SMD = -.24, 95% CI = -.46 to -.01, p = .04) reporting significant effect sizes. Among the patients with breast cancer, MyCB (SMD = -.24, 95% CI = -.46 to -.01, p = .04) showed a significant effect size.

CONCLUSIONS

MBIs appear to be promising interventions in reducing BID among the clinical population. However, findings should be considered cautiously due to the possible publication bias, high heterogeneity and fewer available studies.

Body Dissatisfaction and Health Risk Behaviors Among Middle School Girls

BACKGROUND

Previous studies demonstrate a relationship between body dissatisfaction and substance use and suicidal ideation among older adolescent girls and young women while less documentation exists for early adolescence. This study explored the relationship between reported weight loss attempts and substance use history and suicidal thoughts among younger female adolescents.

METHODS

Participants (n = 1656) were middle school female students who participated in the 2019 Youth Behaviors Risk Survey. Participants were coded as "Trying to lose weight" and "Not trying to lose weight." Two hierarchal multiple binary logistic regressions were conducted, 1 for each of the dependent variables: (1) substance use history and (2) suicidality.

RESULTS

Fifty-seven percent of the participants were trying to lose weight, 40% reported suicidal thoughts and 45% reported substance use history. Trying to lose weight was a significant predictor for both substance use (p < .01) and suicidality (p < .001).

CONCLUSIONS

Body dissatisfaction and its association with risky health behaviors highlight the need for prevention education at earlier ages while reinforcing the need for availability of school counselors.

Associations Between Negative Body Image and Sexual Health Practices in Emerging Adults from Malaysia

Past findings on the association between negative body image and sexual health behaviors have been mixed and mostly derived from Western samples. The aim of the current study was to examine associations between indices of negative body image and sexual health practices that reduce the risk of disease transmission in emerging adults, and whether these associations are moderated by gender. Using an online survey, a convenience sample of 584 Malaysian adults aged 18-30 years (230 men, 354 women) completed measures of satisfaction with overall appearance, body size dissatisfaction, weight satisfaction, height satisfaction, and genital image evaluation. They also reported if they ever had partnered sex, condomless sex, and been screened for human immunodeficiency virus (HIV), as well as their lifetime number of penetrative sex partners. Hierarchical logistic and ordinal regression analyses indicated that more positive genital image evaluation, but not the other body image indices, was significantly associated with having had partnered sex and fewer lifetime penetrative sex partners. None of the body image indices were significantly associated with condomless sex. All associations were consistent across men and women. For HIV testing, a significant interaction between genital image evaluation and gender emerged. However, this was reduced to non-significance after controlling for the number of penetrative sex partners. Overall, our findings underline the importance of promoting improved genital image in interventions aimed at increasing positive sexual health behaviors.

Exposure to Instagram junk food content negatively impacts mood and cravings in young adults: A randomized controlled trial

Exposure to different types of images on social media is known to affect physical and mental wellbeing including changes in perception of body image (BI) and dietary behavior. The present study aimed to assess the effects of junk food-related Instagram content exposure on body image, overall mood, and cravings in young adults. A randomized crossover experimental design was used. After filling out a baseline survey, participants (n = 63, aged 18-24) browsed either a control Instagram account feed or an account rich in junk food images during 15 min. They then filled a short survey evaluating their state BI, mood, and cravings (T1). After a 1-week washout period (T2), participants browsed the other account type followed by the same short survey as in T1. Results showed that exposure to junk food content was associated with increased feelings of hunger, stress, sadness, and exhaustion, in addition to higher salty, savory, and fatty food cravings. Moreover, participants showed higher desire for junk food and lower desire for healthy food items from a virtual food tray after junk food content exposure. There was no impact of content type on state BI dissatisfaction. In conclusion, exposure to junk-food related content on social media negatively affects mood and cravings, subsequently influencing food choices. The present findings shed light on the need for interventions aimed at providing cognitive and emotional competencies for enhancing media literacy and promoting mindful social media use.

New media facilitate adolescents' body dissatisfaction and eating disorders in Mainland China

New media play a significant role in adolescents' body dissatisfaction and eating disorders in Mainland China, through shaping social standards, peers, and family dynamics. How to mitigate their adverse effects on adolescents, reduce body dissatisfaction, and prevent eating disorders is a significant social issue that demands serious consideration.

Flex Friday: A content analysis of men's fitspiration on Instagram

Fitspiration is a social media trend that utilizes images and quotes to promote and inspire physical health and fitness. However, research has shown Fitspiration reinforces the rigidly defined appearance ideal, particularly in women, which can lead to negative body image. There remains limited understanding of the characteristics and impact of men's Fitspiration. The purpose of this content analysis was to investigate the nature, presentation, and text-based messages of male-focused Fitspiration on Instagram. Hashtags (#) were used to collect 1,000 random images from Instagram. Content codes for images included body type, objectification, activities, and messages conveyed. Results showed most images consisted of men accentuating their highly muscular upper bodies with low body fat, consistent with the male appearance ideal. Also, men were often shown engaging in activities irrelevant to health or fitness (i.e., passive modeling) that emphasized their physical appearance. Consistent with research examining female-focused Fitspiration, male-focused Fitspiration reinforces a glamorized appearance ideal with low focus on health and fitness.

Attentional engagement with and disengagement from appearance ideals: Differential associations with body dissatisfaction frequency and duration?

Recent work has served to dissociate two dimensions of trait body dissatisfaction: body dissatisfaction frequency and body dissatisfaction duration. The present study sought to evaluate whether body dissatisfaction frequency and body dissatisfaction duration are each associated with distinct patterns of appearance-related cognitive processing. It was hypothesized that speeded attentional engagement with idealized bodies is associated with higher frequency of body dissatisfaction episodes, while slowed attentional disengagement from such information may instead be associated with higher duration of body dissatisfaction episodes. Participants (238 women, 149 men) completed an attentional task capable of independently assessing attentional engagement with, and attentional disengagement from, idealized bodies. Participants also completed both trait and in vivo (i.e., ecological momentary assessment) measures of body dissatisfaction frequency and duration. Results showed that neither engagement nor disengagement bias index scores predicted variance in either body dissatisfaction frequency measures or body dissatisfaction duration measures. Findings suggest that either biased attentional engagement with, and disengagement from, idealized bodies do not associate with the frequency and duration of body dissatisfaction episodes, or there are other key moderating factors involved in the expression of body dissatisfaction-linked attentional bias.

#mybestmidlife: Profiles of photo-based social media use and body image among midlife women

Empirical data, predominantly from young women, suggest photo-based social media use is associated with greater body dissatisfaction. The present study aimed to extend these findings to midlife women and identify risk profiles for maladaptive appearance-focused social media use. A convenience sample of female Instagram users aged 40 or over (M= 50.92 years) (n = 192) was collected. Most participants were partnered, white, highly educated, and heterosexual. A cluster analysis in cross-sectional data grouped participants into four categories according to body image indices (following body positive or fitness accounts, body appreciation and dissatisfaction, thin and muscular ideal internalization, and appearance comparison). Differences by cluster emerged according to indices of social media use (e.g., photo editing, social media rumination), although following appearance-related content across types seemed to distinguish risk profiles more than the types of appearance-related content engaged with (i.e., body positive vs fitness). Furthermore, results indicated that higher social media use was associated with greater perceived negative effects of social media, suggesting that awareness alone may be insufficient to reduce behavioral risk. Findings indicate that some midlife women who use photo-based social media may be at high risk for appearance concerns, warranting further research and resource development for this group.

Body dissatisfaction and disordered eating symptoms in children's daily life: Can parents protect against appearance comparison on social media?

Research suggests that body dissatisfaction is common among children. However, it remains largely unknown how body dissatisfaction occurs on a daily basis and which environmental factors are linked to this. The purpose of this study was to examine (1) state body dissatisfaction, dietary restraint, compensatory exercise and loss of control eating among children and its association with upward comparisons via social media and (2) whether trust in parents may attenuate this association. Children from 10 to 12 years old (N = 50) were assessed three times a day during a two-week period. Trust was examined via a baseline questionnaire. State body dissatisfaction, dietary restraint, compensatory exercise, loss of control eating and upward comparisons were examined via Ecological Momentary Assessment (EMA). Multilevel analyses indicated that an a higher level of upward comparison is associated with a higher level of state body dissatisfaction, compensatory exercise and loss of control eating. Trust in father significantly moderated the association between appearance comparison and body dissatisfaction. No evidence was found for the protective role of trust in mother. Future research is necessary to enhance our understanding of state body dissatisfaction among children and of environmental factors that may protect children from the adverse effects of social media.

Effects of videoconferencing use on momentary changes in disordered eating urges, body dissatisfaction, and mood

The coronavirus disease 2019 (COVID-19) pandemic led to a global surge in videoconferencing use for work/study-related reasons. Although these platforms heighten exposure to one's image, the implications of videoconferencing use on body image and eating concerns remain scantly examined. This study sought to investigate, in an Australian sample, whether videoconferencing for work/study-related reasons predicted increases in body dissatisfaction (BD), urge to engage in disordered eating (DE; restrictive eating, exercise, overeating/purging), and negative mood at the state level. Participants (N = 482, 78.8% women, Mage  = 20.5 years [SD = 5.3]) completed baseline demographic measures, accompanied by an ecological momentary assessment (EMA) of videoconferencing for work/study-related reasons, BD, DE urges, and negative mood six times a day for 7 days via a smartphone application. Most participants (n = 429; 89.0%) reported state-based videoconferencing use during the EMA phase. Consistent with expectations, state-based videoconferencing use was associated with an increase in state-level urges to engage in exercise. However, contrary to predictions, state-based videoconferencing use was linked to a decrease in state-level BD at the next assessment point and failed to predict negative mood and urges to engage in restrictive eating or overeating/purging at the state level. Given the simplified measure of videoconferencing use, the current research is considered preliminary and future replication and extension, using more nuanced measures, is warranted.

Difficulties in interpersonal regulation of emotion in relation to disordered eating

Eating disorders (EDs) are associated with emotion regulation difficulties. However, most studies have examined intrapersonal emotion regulation difficulties and strategies without consideration of interpersonal emotion regulation (IER). Thus, it remains unknown whether intrinsic IER (i.e., how people regulate their emotions through others) is associated with disordered eating. The present study examined whether putatively maladaptive IER strategies such as reassurance seeking and venting were associated with ED cognitions, behaviors, and symptom severity. Additionally, we examined whether IER strategy use varied as a function of probable ED diagnosis. A sample of 181 college students (Mage = 20.01 years, SD = 2.18) from a large northeastern university completed self-report measures of disordered eating, IER strategies, and intrapersonal emotion regulation difficulties. As predicted, reassurance seeking was associated with most ED symptomatology and ED symptom severity except for fasting frequency. Venting was only associated with body dissatisfaction. Associations between reassurance seeking and ED symptom severity and excessive exercise frequency remained significant even after controlling for sex and intrapersonal emotion regulation strategies. Finally, participants with a probable ED diagnosis reported greater reassurance seeking but not venting compared to nonprobable ED cases. These findings highlight the important associations between IER strategy use and disordered eating, namely, reassurance seeking. Additional research is needed to examine the associations between IER strategy use and disordered eating longitudinally.

Contrasting constructs or continuum? Examining the dimensionality of body appreciation and body dissatisfaction

Individuals experiencing body dissatisfaction have poorer health outcomes in part due to engaging in less physical activity. Body appreciation is protective of health behaviors and proposed to be conceptually different from body dissatisfaction. Two studies evaluated whether body appreciation and dissatisfaction represented two distinct dimensions, and whether body appreciation and dissatisfaction would interact in their effect on activity-related motivation and behavior. Study 1 (n = 313) was prospective and utilized a self-report measure of physical activity whereas Study 2 (n = 123) was prospective and used an objective measure. All hypotheses and analyses were pre-registered. A multiverse approach was taken to demonstrate the robustness of results. In exploratory factor analyses, body appreciation and dissatisfaction did not represent two distinct dimensions of body image as both loaded onto the same factor. This result was largely supported by latent profile analyses, which revealed that participants scored high, moderate, or low on both body satisfaction and appreciation. Additionally, body appreciation did not buffer the negative impact of body dissatisfaction on activity-related motivation and behavior. This study provides the first statistical evaluation of the theoretical proposition that body appreciation and dissatisfaction may be distinct constructs with distinct relationships to outcomes.

Negative body image mental health literacy in women: Exploring aesthetic and functional concerns and the role of self-objectification

Despite its high prevalence in women, few studies have examined lay knowledge and beliefs about negative body image. Yet, studies applying mental health literacy to body image problems suggest recognition of appearance concerns is poor, which could impede help-seeking. The present study extended previous work by investigating problem recognition, beliefs and help-seeking for aesthetic and functional (physical ability focused) body image concerns in women, and the role of self-objectification in help-seeking. A within-subjects online survey design employing the mental health literacy paradigm was undertaken in a sample of 210 female-identifying adults residing in Australia (Mage = 31.25, SD = 12.76). Overall, results indicated that recognition of body image problems depicted via fictional text vignettes was limited. Moreover, recognition, as well as ratings of perceived prevalence, distress, sympathy, affective reactions, and help-seeking recommendations and intentions, were significantly greater for aesthetic compared to functional body image concerns. Self-objectification displayed significant negative associations with help-seeking recommendations for aesthetic (but not functional) concerns, and was not associated with help-seeking intentions. Findings suggest that negative body image mental health literacy is poor in women, particularly in relation to body functionality. More research is needed to facilitate help-seeking and reduce the impact of body image concerns in women.

Body image dissatisfaction during the first year of pediatric inflammatory bowel disease diagnosis

OBJECTIVES

Dissatisfaction with one's body can be distressing; youth with inflammatory bowel disease (IBD) may be at increased risk for body image dissatisfaction given disease symptoms and treatment side effects. Yet, no studies have examined body image dissatisfaction over time in youth with IBD and whether depressive symptoms are associated with change in dissatisfaction.

METHODS

Fifty-seven pediatric participants (8-17 years old) newly diagnosed with IBD were enrolled. Youth completed questionnaires assessing body image dissatisfaction and depressive symptoms shortly after diagnosis (Time 1) and 12 months later (Time 2). Multilevel longitudinal modeling was used to test the extent to which body image dissatisfaction changed across the first year of diagnosis and to test change in body image dissatisfaction as a function of depressive symptoms.

RESULTS

Findings indicated significant between- and within-person variance in body image dissatisfaction over the 12 months, yet the sample as a whole did not report significant changes in dissatisfaction from Time 1 to Time 2. Children reporting depressive symptoms greater than their individual average over time reported greater body image dissatisfaction. Between-person variation in depressive symptoms demonstrated a significant interaction with time. As an individual's depressive symptoms exceeded the group average, their body image dissatisfaction increased, although less drastically as time since diagnosis progressed.

CONCLUSIONS

Findings suggest that body image dissatisfaction is a complex and dynamic construct across youth and that interventions for pediatric IBD patients need to be tailored to the needs of individuals. Methods for assessing body image dissatisfaction efficiently and repeatedly across multiple visits are provided.

Self-awareness and Social Influences as Predictors of Body Dissatisfaction and Acceptance of Cosmetic Surgery for Social Reasons Among Men

BACKGROUND

Body dissatisfaction and the use of surgery for purely aesthetic reasons among men is steadily increasing. Nevertheless, compared to women, few studies have focused on specific sociocultural and individual factors predicting men's body dissatisfaction and interest in cosmetic surgery procedures. The present study investigated the role of media, significant others, public and private self-awareness in predicting men's body dissatisfaction and acceptance of cosmetic surgery for social reasons.

METHODS

Participants were 203 men (mean-age 24 years), who completed a questionnaire containing the Sociocultural Attitudes Toward Appearance Questionnaire-4R, the Situational Self-Awareness Scale, the Muscular internalization subscale, the Male Body Attitudes Scale, and the Social subscale of the Acceptance of Cosmetic Surgery Scale. A path analysis was performed.

RESULTS

The influence of significant others and public self-awareness predicted men's body dissatisfaction directly and indirectly, via muscularity internalization, while media was only directly associated with body dissatisfaction. A significant link between private self-awareness and body dissatisfaction was found. Moreover, media was not associated with cosmetic surgery either directly or indirectly and public self-awareness showed only a significant association with internalization.

CONCLUSIONS

These findings provide information about the role that self-awareness and sociocultural factor play on body dissatisfaction and acceptance of surgery for social reasons among men. The study highlighted the importance of designing preventive programs aimed at enhancing men's ability to resist various forms of pressure regarding body image and its management. Moreover, the advantages of focusing one's attention on internal states and feelings can limit body dissatisfaction and can discourage consideration of cosmetic surgery for social benefits.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

My mother, sisters, and I: Investigating the role of female family members in body dissatisfaction and disordered eating behaviours among young Middle-Eastern women

The global rise in body dissatisfaction and disordered eating concerns is apparent; however, limited research in Middle-Eastern populations gives an incomplete understanding of these concerns. The present study recruited 377 young women aged 18 to 25 years from the Middle-East for an online survey to determine how female family members may contribute to body dissatisfaction and disordered eating behaviours. Guided by the Tripartite Influence Model, we investigated the relationships between appearance pressures and fat talk, from mothers and sister(s), in predicting body dissatisfaction, and in turn, disordered eating symptomatology (restriction and bulimia), as mediated by appearance comparisons and internalisation of the thin-ideal. Overall, greater appearance pressures and fat talk from mothers and sister(s) were associated with body dissatisfaction and disordered eating symptomatology. Greater reported closeness in mother-daughter relationships, but not sister relationships, was associated with less perceived appearance pressure and fat talk by mothers, and lower appearance comparisons, body dissatisfaction and bulimia symptomatology. Finally, participants perceived greater appearance pressure from their mothers than their sister(s), but there was no difference in their perceived levels of fat talk. Findings demonstrate the applicability of a subsection of the Tripartite Influence Model in a non-Western and understudied population, namely in young Middle-Eastern women.

Body dissatisfaction, negative affect, and engagement in healthy behaviors: The conditional effect of future-self continuity

The relationship between body dissatisfaction and negative affect is complex, with some research suggesting that this combination motivates individuals to engage in more health-related behaviors; while other studies find it increases unhealthy behavior. To bridge this gap, it may be the case that to the extent these individuals have continuity between their present and future selves, the more likely they are able to make positive health-related choices with this future self in mind. We examined individuals (n = 344; 51.74% men) aged between 18 and 72 years (M = 39.66, SD = 11.49) who endorsed high negative affect along with body dissatisfaction but either had high or low levels of future self-continuity. We found individuals experiencing body dissatisfaction and negative affect reported higher engagement in healthy behaviors only if they had a strong connection to their future self, index of moderated mediation = 0.07 (95% CI = 0.02, 0.13). These findings support targeting future-self continuity in therapeutic regimens to bolster engagement in healthy behaviors among individuals with body dissatisfaction and high negative affect.

[Body dissatisfaction, self-esteem, depressive symptoms, and nutritional status in adolescents]

In adolescence and especially in females, greater body dissatisfaction has been evidenced, which is defined as a negative evaluation of one's own body, being a strong predictor of eating disorders and obesity.

OBJECTIVE

To relate body dissatisfaction with self-esteem, depression, and body mass index in adolescents.

SUBJECTS AND METHOD

Quantitative, correlational, and cross-sectional study in a sample of 397 school adolescents (180 males and 217 females) from Concepción, Chile, aged 10 to 19 years, to whom the following instruments were applied: Body Shape Questionnaire (BSQ) to assess body dissatisfaction, Rosenberg Self-Esteem Scale, Beck's Depression Inventory-II for those older than 14 years, and Birleson Depression Self-Rating Scale for those younger than 14 years. Body mass index z-score was determined. Spearman's correlation coefficient was estimated for all variables.

RESULTS

Body dissatisfaction was reported in 54.9 % of females and 18.3 % of males. Body dissatisfaction was positively correlated with age, z-BMI, and depression (p < 0.01) and negatively correlated with self-esteem (p < 0.01). When body dissatisfaction was differentiated by sex, the same significant correlations remained, except for age.

CONCLUSIONS

The results confirm the relationship between body dissatisfaction with self-esteem, depression, and BMI. The importance of promoting healthy self-esteem and body image from an early age to prevent eating disorders and obesity is emphasized.

Predictors of body image dissatisfaction among women at different stages of pregnancy:A cross-sectional study

OBJECTIVE

To explore the levels and predictors of body image dissatisfaction among women at different stages of pregnancy.

DESIGN

This was a cross-sectional study design.

SETTING AND PARTICIPANTS

A total of 863 Chinese pregnant women were recruited from a tertiary hospital via a convenience sampling method.

MEASUREMENT AND FINDINGS

Eligible participants completed a demographic questionnaire and self-reported measures of body image dissatisfaction, pregnancy-related anxiety, prenatal depression, and appearance comparison. Results showed no statistical difference in body image dissatisfaction levels among early-mid pregnancy (47.6 ± 6.17), late-mid pregnancy (47.3 ± 7.56), and late pregnancy stages (48.4 ± 6.22). The generalized linear model showed that gestational weight gain, pregnancy-related anxiety, own/family's perception of pregnancy weight, and current ideal weight change were predictors of body image dissatisfaction in the early-mid pregnancy stage. In addition, pre-pregnancy BMI, appearance comparison, own /family's perception of pregnancy weight, current ideal weight change, and overeating during pregnancy significantly predicted body image dissatisfaction in the late-mid pregnancy stage. Predictors of body image dissatisfaction in the late pregnancy stage comprised planned pregnancy, pre-pregnancy eating disorders, own perception of pregnancy weight, current ideal weight change, pregnancy-related anxiety, and prenatal depression.

KEY CONCLUSION AND IMPLICATION FOR PRACTICE

The findings suggest that predictors of body image dissatisfaction differed according to pregnancy stage. Self-perception of pregnancy weight was primary predictor of body image dissatisfaction. Healthcare professionals are recommended to provide prenatal health education to reduce own/family's negative perception of pregnancy weight, so as to alleviate the body image dissatisfaction level of pregnant women.

[Body image dissatisfaction and low adherence to the Western dietary standard among schoolchildren: a cross-sectional study]

This study aimed to identify dietary patterns and to evaluate the association between body image perception and these patterns among schoolchildren. A cross-sectional study was conducted on 385 schoolchildren (both sexes, 10-17 years old) from four public schools in Salvador, Brazil. Two non-consecutive 24-hour dietary recalls were applied, and the dietary pattern was determined by Exploratory Factor Analysis after adjustment of dietary data using the Multiple Source Method. To evaluate body image perception, the Brazilian body shape silhouette was used. The associations between body image perception and dietary patterns using the polytomous logistic regression model adjusted for covariables was assessed. Three dietary patterns were obtained: "Western standard," unhealthy, "healthy pattern" and "typical dishes/ junk food." After adjustment, adolescents who wished for a slimmer silhouette (2.48 [95%CI: 1.04-6.11], 3.49 [95%CI: 1.35-9.05] and 2.87 [95%CI: 1.13-7.26]) were more likely to adhere to the quintiles with the lowest consumption of the Western standard, compared to those satisfied with their body image. No associations were identified in the other two dietary patterns. Adolescents dissatisfied with their bodies tend to adhere less to unhealthy dietary patterns.

Disordered eating in a 10-year perspective from adolescence to young adulthood: Stability, change, and body dissatisfaction as a predictor

INTRODUCTION

Although there are many studies of disordered eating (DE) in adolescence, studies examining the longitudinal stability and change of DE and its longitudinal associations with other factors are still rather scarce. Such studies are important to inform parents and clinicians how stable DE is and to what extent it will go away with increased maturity. Longitudinal studies may also be of help in establishing predictors of long-term problems. The purpose of the present study was to investigate the stability of DE over a 10-year period from early adolescence to young adulthood, and to explore body dissatisfaction as a predictor in a 10-year perspective.

METHODS

Data were taken from a three-wave longitudinal project (SoL) with survey data collected among the students in Grades 7and 8 in a Swedish municipality in 2007 (T1), 1 year later (T2), and in a 10-year follow-up in 2017 (T3). DE was measured by the eight-item version of the Risk Behaviour Related to Eating Disorders (RiBED-8), and a quasi-clinical criterion of six or more critical answers on the RiBED-8 was used to classify DE cases.

RESULTS

Of the girls, 5.8% passed the cutoff for DE at T1, whereas 9.1% did so at T2 and 7.9% at T3. The boys showed markedly lower figures: 0.5% both at T1 and T2, and 1.5% at T3. There was significant individual stability of DE over the 10-year period, with almost 30% of the girls who passed the cutoff for DE at T1 also doing so 10 years later. Body dissatisfaction in early adolescence predicted the incidence of new cases of DE 10 years later, even when controlling for degree of DE in early adolescence. The results also indicate that DE in early adolescence may be a passing phase among adolescents who express relatively high body satisfaction.

CONCLUSIONS

The present results show a complex picture of different individual trajectories of DE, with degree of body satisfaction playing a significant role for the outcome in a 10-year perspective. Body dissatisfaction appears to be a risk factor for the development of new cases of DE, whereas body satisfaction may protect against the continuation of DE into adulthood.

Variables that explain disordered eating behaviors among women: the mediating role of body dissatisfaction

PURPOSE

To analyze the role of body dissatisfaction in the relationships of sociocultural influences, depression, and anxiety with disordered eating behaviors (DEB) in a sample of female Mexican university students.

METHODS

A nonrandom sample of 526 female Mexican university students aged 18 to 25 years completed the Questionnaire of Influence on the Aesthetic Model of Body Shape (CIMEC-26), the Hospital Anxiety and Depression Scale (HADS), the Body Shape Questionnaire (BSQ-8D) and the Eating Attitudes Test (EAT-26).

RESULTS

Through the mean model (χ2/df (5, n = 526) = 7.298, p = .199; NFI = .996; CFI = .999; RMSEA = .030; SRMR = .011), body dissatisfaction was found to mediate the relationships of influence of advertising, influence of social models and anxiety with DEB (restrictive dieting and bulimia). The variable with the most direct effect on restrictive dieting and bulimia was the influence of advertising. Body dissatisfaction partially mediated this relationship, as the influence of advertising had a significant direct effect on restrictive dieting and bulimia. The final model of direct and indirect effects explained 43% and 22% of the variance in restrictive dieting and bulimia, respectively.

CONCLUSION

The present study showed that body dissatisfaction partially mediated the relationships between influence of advertising, influence of social models, and anxiety with DEB among women. Thus, these variables should be taken into account in prevention and intervention programs targeting BED.

LEVEL V

Evidence obtained from a cross-sectional descriptive study.

LEVEL V

Evidence obtained from a cross-sectional descriptive study.

Longitudinal pathways between childhood BMI, body dissatisfaction, and adolescent depression: an observational study using the UK Millenium Cohort Study

BACKGROUND

Globally, more adolescents are having depressive symptoms than in the past. High BMI is a risk factor for depressive symptoms, potentially acting via increased body dissatisfaction. Robust longitudinal evidence of these associations could help to inform preventive interventions, but such evidence remains scarce. We investigated the longitudinal associations between BMI at age 7 years and depressive symptoms at age 14 years (objective 1), BMI at age 7 years and body dissatisfaction at age 11 years (objective 2), and body dissatisfaction at age 11 years and depression at age 14 years (objective 3). We also investigated the extent to which body dissatisfaction mediated the association between BMI and depressive symptoms (objective 4).

METHODS

This study used data from the Millennium Cohort Study, a representative longitudinal general population cohort of UK children born between Sept 1, 2000, and Jan 11, 2002. We used univariable and multivariable linear regression models to investigate the associations in objectives 1-3 adjusting for a range of child-level and family-level confounders. For mediation analyses we used non-parametric g-formula (objective 4). We reported stratified results in presence of sex differences. All analyses were based on participants with complete BMI data and imputed confounders and outcomes.

FINDINGS

Our sample included 13 135 participants. Of these, 6624 (50·4%) were male participants and 6511 (49·6%) were female participants; 11 096 (84·4%) were of White ethnicity and 2039 (15·6%) were from a minority ethnic background. At baseline, mean age was 7·2 years (SD 0·25, range 6·3-8·3). In multivariable models, an SD increase in BMI at age 7 years was associated with greater depressive symptoms at age 14 years (estimated regression coefficient [coeff]: 0·30, 95% CI 0·17-0·43) and greater body dissatisfaction at age 11 years (coeff 0·15, 0·12-0·18). Greater body dissatisfaction at age 11 years was associated with higher depressive symptoms at age 14 years (coeff 0·60, 0·52-0·68). All these associations were twice as large in girls as in boys. Body dissatisfaction explained 43% of the association between BMI and depression in girls.

INTERPRETATION

Our findings bear relevance for interventions aimed at reducing weight in childhood and reducing body dissatisfaction. Implementation of evidence-based body image interventions and identification of drivers of weight stigma should be key public health priorities. Interventions aiming to reduce weight in childhood need to avoid increasing body dissatisfaction and should target environmental drivers of weight rather than individuals.

FUNDING

Wellcome Trust; The Royal Society; Economic and Social Research Council; and the National Institute for Health and Care Research.

Pressures to be "shedding for the wedding": An evaluation of the tripartite influence model of disordered eating and body dissatisfaction among engaged women

Disordered eating and body image concerns are particularly prevalent among women who are engaged to be married (i.e., brides-to-be), and this population may be subject to increased social and cultural pressure to achieve specific appearance ideals. The tripartite influence model purports that appearance pressures from four sources (peers, family, romantic partners, and media) influence body image and disordered eating outcomes through thin ideal internalization and appearance comparison. The present cross-sectional study sought to examine the relationships between tripartite theory constructs, body image, and disordered eating among 329 brides-to-be using path analysis with robust estimation. In the final model, media influence was the only tripartite predictor associated with both thin ideal internalization and appearance comparison. Further, thin ideal internalization and appearance comparison were associated with disordered eating directly as well as indirectly through body dissatisfaction. Altogether, the influence variables explained 39 % of the variance in disordered eating. While appearance pressures from media, peers, and partners were indirectly associated with disordered eating through one or more hypothesized indirect pathways, appearance pressure from family was not, indicating this relationship may be uniquely impacted by other factors not captured in tripartite models. Results suggest that family and media influence are most strongly associated with disordered eating in this group and have the capacity to inform future research as well as intervention development and dissemination.

Impact of COVID-19 on negative body image: Evidence based on social media data

Body experiences and conditions bear close relations to social development and human well-being. However, no consensus has been reached regarding the impact of coronavirus disease 2019 on negative body image. Investigating a reliable relationship between COVID-19 and negative body image, we developed a dictionary of negative body image to obtain panel data on body image for 31 Chinese provinces/municipalities/autonomous regions. We compared negative body image before and after the pandemic and explored the impact of pandemic severity. The prevalence of negative body image decreased following the outbreak and remained at a relatively low level for two years. After controlling regional and temporal effects, we verified epidemic severity as an important predictor of the decline in negative body image. The findings suggest that the public is likely to accept their physical appearances during lockdown due to changes in lifestyle and the fear of mortality. This research has important implications for gaining insights into the dynamic transformation of public negative body image under the influence of catastrophic public health events.

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.

The Longitudinal Associations of Body Dissatisfaction with Health and Wellness Behaviors in Midlife and Older Women

Emerging research suggests that body dissatisfaction (BD) is prevalent among midlife and older women (i.e., upwards of 70%). Cross-sectionally, BD is associated with myriad poor health and wellness outcomes (e.g., depression, disordered eating, bad nutrition) in midlife/older women. However, relatively few studies have examined the longitudinal relations between BD and health outcomes in this population. This preliminary study investigated the longitudinal associations of BD with wellbeing and health-related quality of life (QOL) among midlife/older adult women over one year. Participants (n = 86, women aged 40-72 years, M = 51.49, SD = 7.34, 86% white) completed self-report measures of BD, psychosocial impairment, health behaviors, and QOL at baseline (T1) and 12-month follow-up (T2). A series of multiple linear regression models included T1 BD as the predictor variable of health outcomes at T2, covarying for T1 BMI and age in all models. BD was associated with greater negative emotions and psychosocial impairment, less physical activity enjoyment, and poorer physical, psychological, and social QOL one year later. Findings suggest that BD is associated with negative consequences for women across the lifespan (ƒ2 ranges = 0.06-0.60). Future research investigating BD as a unique, modifiable risk factor for health outcomes among diverse samples of midlife/older women is warranted. Targeting BD in interventions may improve health indices beyond eating disorders for this population.

Intolerable feelings of uncertainty within the body: Associations between interoceptive awareness, intolerance of uncertainty, and body dissatisfaction

BACKGROUND

Adolescence is a period marked by important physical and social changes, which often leads to an increase of body dissatisfaction. Recent studies have shown an association between interoception and body dissatisfaction in female adolescents. One variable that may contribute to the association between interoceptive awareness and body dissatisfaction is intolerance of uncertainty (IU). This study aims to investigate multiple facets of interoceptive awareness, IU, and their relations with body dissatisfaction in adolescent girls.

METHODS

In a cross-sectional study, a convenience sample of 307 adolescent girls (mean age = 17.73; SD = 1.02) was recruited in the Netherlands in 2022. Three questionnaires were completed measuring interoceptive awareness, IU, and body dissatisfaction. A moderation analyses using a multiple hierarchical regression was used to investigate associations between variables.

RESULTS

Correlation analyses indicated that several facets of lower interoceptive awareness (Not distracting, Not worrying and Trusting) were related to higher levels of body dissatisfaction. IU only marginally moderated the relationship between several domains of interoceptive awareness (Notice, Attention regulation and Emotional awareness) and body dissatisfaction.

DISCUSSION

Findings suggest that experiencing bodily signals as ambiguous and uncertain may result in more complex body image issues. Within certain domains of interoceptive awareness, IU may affect the process of appraising bodily signals. Furthermore, adolescent girls who do not feel safe in their body and who find it difficult to distract their thoughts when experiencing pain or discomfort in their body may be particularly at risk for developing more complex body image disturbances and may benefit from interventions improving both interoceptive awareness and IU. Moreover, future research should focus on interoceptive awareness and IU as potential underlying mechanisms for body image issues.

Problematic alcohol use and food and alcohol disturbance in mothers: Examining the role of stress, body dissatisfaction, and wine-mom-consistent drinking

OBJECTIVE

In recent years, women have significantly closed the alcohol use gender gap-and they are drinking more heavily now than in previous decades (Keyes et al., 2019). Furthermore, "wine-mom" culture (which promotes the use of alcohol to cope with the stressors of parenthood) has become increasingly prevalent in society and may be a factor in mothers' alcohol use. In the present study, we examined wine-mom-consistent drinking (whether one's alcohol use corresponds to that promoted by wine-mom culture) as a moderator in the relationship between psychosocial predictors (stress, body dissatisfaction) and alcohol-related outcomes (problematic alcohol use, food and alcohol disturbance-FAD).

METHODS

Participants were mothers (Mage = 40.18, SD = 8.28) recruited through Prolific from both the United States and the United Kingdom (n = 466; 50 % from the US and UK each); they completed the study via a Qualtrics survey.

RESULTS

In the models tested, stress interacted with wine-mom-consistent drinking in predicting FAD (alcohol effects and restriction dimensions), and body dissatisfaction interacted with wine-mom-consistent drinking in predicting the FAD restriction dimension. Compared to those who did not endorse wine-mom-consistent drinking, the relationship between the predictors and the FAD dimensions was stronger among participants who endorsed wine-mom-consistent drinking. Body dissatisfaction and wine-mom-consistent drinking also emerged as significant independent predictors in some of the models.

CONCLUSION

Wine-mom-consistent drinking is associated with problematic alcohol use and FAD among mothers. Further research is needed to better understand wine-mom culture and related psychosocial factors in mothers' drinking motives and behaviors.

Comparing measurement of internalized weight stigma and body dissatisfaction

Respective conceptualizations of internalized weight stigma and body dissatisfaction are distinct; however, strong relationships between measures of these two constructs prompts consideration about if these are truly unique constructs or whether current measurement tools are not adequately capturing their uniqueness. In this cross-sectional study, 480 U.S. women (78.8% white; MBMI = 25.9) ages 18-40 years, recruited from Amazon's MechanicalTurk and a mid-sized university, completed an online survey with the Modified Weight Bias Internalization Scale (WBIS-M), a modified Body Parts Satisfaction Scale (BPSS), and other validated measures of body image, eating behavior, and mental health. Exploratory factor analysis of the WBIS-M and the BPSS supported a two-factor solution, although two items from the WBIS-M loaded with BPSS items. After removing these items, the 9-item version of the WBIS-M demonstrated stronger relationships with dysfunctional eating and mental health symptoms than did the BPSS (ꞵ range = 0.32-0.62 vs. 0.01-0.18, respectively). Findings from this study provide evidence to support the validity of WBIS-M and BPSS measuring unique constructs, suggesting that internalized weight stigma can be differentiated from body dissatisfaction. This study also highlights the need for further research that examines current measurement tools for internalized weight stigma and body dissatisfaction.

A qualitative exploration of positive body image experiences among nonbinary individuals

One group whose positive body image experiences remain under-explored is individuals who identify as nonbinary, gender fluid, and/or genderqueer (including other nonbinary identities). Thus, we sought to answer the questions: What does it look like to have a positive body image for a nonbinary person? and How do nonbinary persons form and maintain a positive body image? To answer these questions, we conducted in-depth, semi-structured interviews with 15 nonbinary individuals who were assessed as having positive body image using the Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015a). Data were analyzed using reflexive thematic analysis. Four themes were identified as characterizing the core features of positive body image among nonbinary persons: body appreciation, body- and self-acceptance, bodily appearance embodied their authentic self, and holding flexible ideals for ways of being. Six themes were identified as related to on-going processes that explain how body image is formed and maintained among nonbinary persons: reframing negative body image information, staging resistance, experiencing representation, receiving and giving social support, practicing self-compassion and self-care, and using dress to create a satisfying presentation of self. In keeping with the tenets of queer theory, findings reflected how gender identity set a context for participants' positive body image experiences.

Enhancing body image in motherhood: A randomised controlled trial of Expand Your Horizon among mothers of young children

Motherhood can increase vulnerability to body dissatisfaction, but positive body image interventions may mitigate this. Expand Your Horizon (Alleva et al., 2015), an online writing intervention, enhances functionality appreciation, an aspect of positive body image. The intervention's demonstrated efficacy and focus on body functionality indicate its potential use among mothers. However, its original 3-session format may be unfeasible for mothers alongside other commitments. Thus, we tested the impact of a single 15-minute Expand Your Horizon session on state body appreciation and functionality appreciation. Mothers (N = 143) of 0-10-year-olds were randomly allocated to either the intervention group, or an active control group. State body appreciation and functionality appreciation were assessed pre- and post-intervention. Trait self-compassion was tested as a potential moderator. Participants who completed Expand Your Horizon reported greater state body appreciation and functionality appreciation post-intervention than those in the control group. Self-compassion moderated the intervention's effect on state functionality appreciation, with effects strongest for those with lower levels of self-compassion. Overall, findings support the intervention's suitability for mothers, particularly those with low self-compassion. Practical implications include possibly tailoring Expand Your Horizon and similar interventions to benefit all mothers. Future research directions include longitudinal and qualitative designs, and extension to other specific populations.

Appearance comparison on Instagram: The impact of fitspiration and transformation imagery on young women's body satisfaction

Fitspiration, or imagery of thin muscular individuals that displays their physiques while posing or exercising, is a popular type of content on Instagram which ostensibly exists to encourage individuals to engage in a healthy lifestyle. A subtype of fitspiration imagery, "transformation" imagery, depicts physical changes following a "lifestyle change" involving diet and exercise. Despite its intentions, fitspiration imagery largely promotes one idealized body type (the fit ideal) and can be accompanied by messages encouraging restrained eating. Viewing fitspiration imagery has been associated with body dissatisfaction and appearance comparison in women, but the impact of transformation imagery specifically on women's body image has not yet been studied, nor has the impact of the broader fitspiration category and the transformation subtype on women's body image been compared. The current study aimed to clarify the relations between fitspiration and transformation imagery, appearance comparison, and body satisfaction using an experimental design. Female participants (N = 161) completed a measure of body satisfaction and then were randomly assigned to view one of three types of images: fit ideal only, body transformation, or travel (control). Participants then completed measures of appearance comparison and body satisfaction. Viewing fit ideal only and body transformation imagery was associated with lower body satisfaction and higher appearance comparison. The relation between image type and changes in body satisfaction was mediated by appearance comparison. Findings suggest that individuals may benefit from limiting exposure to fit ideal and body transformation imagery, particularly if they are vulnerable to engaging in appearance comparison.

Birds of a feather flocking together on Instagram: How racially similar followers and followings on Instagram are linked to young women's body image

In light of recent studies demonstrating the detrimental effects of social media use on young women's body image, we examined the racial composition of young women's Instagram followers, as well as the racial composition of the individuals in young women's followed Instagram accounts, in relation to their appearance ideals and body image. Based on social identity theory (Tajfel & Turner, 1979), we tested two main propositions. First, women who have racially similar followers and followed accounts will be more likely to internalize body ideal preferences that are relevant to their in-group (i.e., thinness for Asian-American and White women; curviness for Black and Latina women). Second, following and being followed by people of one's racial identity in-group will have ameliorative effects on young women's body image (i.e., more body appreciation; less body dissatisfaction). Our sample included 533 U.S. women who identified as Asian-American (n = 97), Black (n = 101), Latina (n = 98), or White (n = 237). The results provided more support for the notion that racially similar followers and accounts followed are related to better body image outcomes rather than to the internalization of body ideals. Specifically, following a higher percentage of racially similar accounts was positively associated with body appreciation among Asian-American and White participants and negatively associated with body dissatisfaction among Asian-American participants. Likewise, being followed by a higher percentage of racially similar others was positively associated with body appreciation among Asian-American, Black, and White participants, and negatively associated with body dissatisfaction among Latina participants. The findings are discussed in light of social identity theory.

'I wish my body looked like theirs!': How positive appearance comments on social media impact adolescents' body dissatisfaction

Despite robust research evidence for the role of attractive-body portrayals in body image, the effect of positive appearance comments that endorse them on social media remains unclear. Therefore, using a between-subject experimental design and the data from 613 Czech adolescents (52% girls) aged 13-18 (M = 15.5, SD = 1.7), the present study examined exposure to positive appearance comments on body dissatisfaction, and the moderating roles of media-ideal internalization, appearance schematicity, body appreciation, and gender. Our data supported the presumed intensifying effect of the positive appearance comments on post-exposure body dissatisfaction, but only for adolescent girls. The impact of positive comments was not moderated by the media-ideal internalization, appearance schematicity, or body appreciation. However, the exploratory results showed that the displayed bodies' perceived attractiveness intensified the positive comments' effect on body dissatisfaction, which makes it a potentially important factor to target for the prevention of negative social media effects on body image. Furthermore, the individual characteristics that moderated the exposure to attractive images in the prior research may not determine the effects of the positive comments. Future research may need to capture factors that specifically influence the processing of such comments, such as susceptibility to peer feedback on physical appearance.

How effective are psychosocial interventions at improving body image and reducing disordered eating in adult men? A systematic review

Disordered eating and body image concerns significantly impact a growing number of men. This systematic review assessed the evidence of the effectiveness of psychosocial interventions to improve body image and eating pathology in men. Searches were conducted in December 2022 in 13 databases (PsycINFO, MEDLINE, CINAHL Plus, AMED, PubMed, Scopus, Cochrane, EMBASE, ASSIA, British Nursing Index, Wiley and OpenGrey). Studies that quantitatively evaluated psychosocial interventions and reported pre-post body image or disordered eating outcomes in men aged 18 years and over were eligible. Articles including boys, uncontrolled designs, or not in English were excluded. Findings were narratively synthesised and presented according to intervention approach. Quality was assessed using EPHPP. Eight studies including six RCTs were reviewed. Five were assessed as being moderate quality and three as weak. Evidence from moderate quality studies suggested that dissonance-based interventions showed promising improvements in body image and disordered eating for up to six months post-intervention in men with and without body dissatisfaction. Evidence for media literacy and psychoeducational interventions was limited. Findings were limited by heterogeneity in outcome measures and homogeneity of participants preventing generalisability. Robust research with longer follow-ups is needed to confirm effectiveness.

Anxiety and Negative Body Image are Associated with Binge Eating in Patients Who Underwent Bariatric Surgery a Minimum of 2 Years

PURPOSE

Bariatric surgery is an effective method for the treatment of severe obesity, however, binge eating disorder (BED) and negative body image can interfere with post-surgical evolution.

OBJECTIVE

To describe the factors associated with BED in bariatric patients with a minimum of 2 years post-surgery.

MATERIALS AND METHODS

A cross-sectional observational study conducted with patients who underwent bariatric surgery through the Unified Health System (Sistema Único de Saúde [SUS]) and presenting a minimum of 2 years post-surgery. BED, depression symptoms, anxiety symptoms, quality of life and body image concerns were assessed by the Binge Eating Scale, Beck Depression Inventory, Beck Anxiety Inventory, Bariatric Analysis and Reporting Outcome System, and Body Shape Questionnaire, respectively. Socioeconomic and anthropometric data were also collected.

RESULTS

Based on the ninety-two (92) patients evaluated, 83.7% were female, and had a mean age of 43.3 ± 9 years. Symptoms of depression (p = 0.002), anxiety (p = 0.000), body image concerns (p = 0.000), poor quality of life (p = 0.010), and obesity (p = 0.008) were associated with the presence of BED. All the anthropometric variables were higher in patients with BED, except excess weight loss. Regression analysis predicted BED through the presence of body image concern and anxiety symptoms.

CONCLUSION

Anxiety symptoms and body image concerns are associated with BED in patients who underwent bariatric surgery a minimum of 2 years.

Skepticism of and critical thinking about media messages: Conflicting relationships with body dissatisfaction

Despite the theoretical connection between media literacy and body dissatisfaction, empirical findings about their relationship are decidedly mixed. There is not a clear explanation for these discrepancies. The present study aimed to 1) compare the attitudes young adult women with those of a reference group of adolescents to examine whether similar values were observed despite differences in age group and racial/ethnic identity, 2) to examine the relationships between media literacy and body dissatisfaction using recommended measures of media literacy. Racially diverse female undergraduate students (N = 152, Mage = 21.62) completed the Media Attitudes Questionnaire, the Critical Thinking about Media Measure, and the Body Shape Questionnaire online. Young adult women endorsed greater critical thinking about media messages and greater skepticism towards the similarity of media messages than adolescents. Additionally, greater skepticism towards the desirability and realism of media messages was associated with lower body dissatisfaction while greater critical thinking about media messages was found to be positively related to greater body dissatisfaction. It is possible that greater critical thinking within the context of media literacy cannot occur without increased attention towards or time spent thinking about media messages. Findings suggest that enhancing critical thinking about the media may not be the main mechanism of change for effective media literacy interventions. These findings underscore the complexities that exist within the relationships between media literacy and body dissatisfaction and highlight the continued need for research in this area.

Protocol of a cluster randomised trial of BodyKind: a school-based body image programme for adolescents

BACKGROUND

Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context.

METHODS

We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up.

CONCLUSION

This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools.

TRIAL REGISTRATION

The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993 .

Body image dissatisfaction and its relation to body mass index among female medical students in Sudan: across-sectional study 2020-2021

BACKGROUND

Body image is mainly determined by biological, social, psychological and cultural factors thus it is a multifaceted vigorous construct. Body image is an essential aspect of girls' self-definition and individual identity. Excessive concern about body image and body image misconceptions leads to dissatisfaction, disturbed eating patterns, affecting the nutritional status and also leading to depression and anxiety disorder.

METHODS

This is a descriptive cross-sectional university-based study aiming to investigate body image dissatisfaction and its relation to BMI among female medical students at the University of Khartoum, faculty of medicine. The study was carried out between December 2020 and January 2021. Simple random sampling was applied and a two-sectioned questionnaire was used. The first part consisted of socio-demographic data and the second part contained questions to assess body image the data was. A total of 277 participants were enrolled in the study. Data was analyzed using SPSS version 20.

RESULTS

We enrolled 277 female medical students the majority of participants (53%) were considered of normal weight according to BMI, 7% considered obese, and 18% underweight. Large number of participants thought that they are not in the ideal weight according to their height (62%). (21% to 17%) of participants always feel pressure from people or society to get to a certain weight. With respect to attitude towards weight, (29%) of participants always wear clothes that don't reveal their body shape, (35%) of them always tend to wear clothes that hide their excess weight.

CONCLUSIONS

The study concluded that participants who were overweight, obese or underweight have significant increase risk for poor body image perception with odd ratio of 39, 11, and 59 respectively. Thus early and proper interventions are necessary to circumvent the impact and future repercussion of body image distortion.

Body Dissatisfaction Directs Avatar Perception: Embodiment and Selective Visual Attention in Body Mass-Modified Self-Avatars

Human agents immersed in metaverse technologies such as virtual reality (VR) are routinely disconnected from their actual physical appearance and embodied in another virtual body, referred to as self-avatar. Such body transformations can have implications for patients with eating disorders, or persons with extreme body dissatisfaction (BD). Changes in BD, weight anxiety, or body image are theoretically linked to visual selective attention, which can be measured with eye tracking. In the present study, 43 women with high or low BD were immersed in animated body weight-manipulated self-avatars in VR. Before a brief mirror exposure with their self-avatars, they experienced synchronous visuomotor and visuo-tactile contingencies in VR to increase embodiment, delivered through small movement exercises with real-time animation from first-person perspective and passive haptics. In a crossover study design, self-avatar weight was manipulated (normal weight vs. overweight) in both groups (low BD vs. high BD), and subjective experience was assessed before and after exposure. In contrast to our hypotheses, BD was not affected by the self-avatar condition. Embodiment decreased during mirror exposure, possibly due to the avatars wearing head-mounted displays. Interestingly, disembodiment was stronger in women with low BD. Furthermore, eye tracking showed that participants with high BD looked longer at weight-related body parts when immersed in the overweight self-avatar, whereas participants with low BD looked longer at weight-related body parts when immersed in the normal weight self-avatar. Overall, the results support body-specific visual attention and suggest that particularly participants with low BD show stronger disembodiment during self-avatar mirror exposure, possibly alleviating momentary body experience. Preregistration: https://doi.org/10.23668/psycharchives.4949.

The effects of body dissatisfaction, sleep duration, and exercise habits on the mental health of university students in southern China during COVID-19

Following the outbreak of COVID-19 at the end of 2019, universities around the world adopted a closed management model and various restrictive measures intended to reduce human contact and control the spread of the disease. Such measures have had a profound impact on university students, with a marked increase in depression-related psychological disorders. However, little is known about the specific status and factors influencing the impact of the pandemic on student mental health. Addressing this gap, this study examines the body dissatisfaction, physical activity, and sleep of university students during the pandemic, and uses their levels of depression to provide a theoretical basis for the development of mental health interventions for university students in the post-epidemic era. To achieve this, a total of 1,258 university students were randomly recruited for this cross-sectional study. Collected data included respondents' anthropometric measurements, body dissatisfaction levels, dietary habits, sleep status, physical activity levels, and depression levels. The overall detection rate of depression was 25.4%, with higher levels of depression among women. Multiple regression analysis showed that the PSQI score (β = 1.768, P < 0.01) and physical activity scores (β = -0.048, P < 0.01) were significant predictors of depression in men, while the PSQI score (β = 1.743, P < 0.01) and body dissatisfaction scores (β = 0.917, P < 0.01) were significant predictors of depression in women. Mental health problems were prevalent among university students during the COVID-19 pandemic. Results indicate the possibility of alleviating depression among university students by improving their body dissatisfaction, physical activity, and sleep. However, as this study was limited to Ganzhou City, it is challenging to extrapolate the findings to other populations. As this was a cross-sectional study, a causal relationship between depression levels and lifestyle habits cannot be determined.

Comparing body image dissatisfaction between pregnant women and non-pregnant women: a systematic review and meta-analysis

Body image dissatisfaction refers to negative thoughts and feelings individuals have towards their own body appearance and this is thought to be affected by the physiological changes that occur during pregnancy. There are two main conflicting theories as to the effect pregnancy has on body image dissatisfaction: 1) Pregnancy related changes are in direct conflict with social ideas of female beauty (e.g. weight gain) and so increase body image dissatisfaction; 2) Due to changes in expectations of bodily appearance during pregnancy, women are liberated from social ideals at this time and thus body image dissatisfaction would decrease. This study aimed to assess these theories by synthesising the current literature. Six databases were searched, and 2,017 study abstracts were screened based on strict inclusion and exclusion criteria. Following screening and quality assessment by two blind reviewers, 17 studies (comprising 17 effect sizes) were subject to full review and meta-analysis following PRISMA guidelines. These studies included cross-sectional, longitudinal and retrospective designs. Results varied with some studies showing women to feel more positive about their body during pregnancy, others showing a more negative body experience and yet others showing no statistical difference. Overall the analysis showed no statistical difference in body image dissatisfaction between pregnant women and non-pregnant women (p = 0.39). Any changes that do occur are heterogeneous and likely to be largely dependent on the individual experience as well as moderator variables and other factors such as differences in methodology of research studies. Studies in this field of research would benefit from more explicit and complete reporting of data and key variables, in order to allow early intervention for women who display body image dissatisfaction in pregnancy.

A Slim Majority: The Influence of Sex Ratio on Women's Body Dissatisfaction and Weight Loss Motivations

The current investigation examined whether women's perceptions of the sex ratio (ratio of women to men) in the local population influence their body dissatisfaction and weight loss motivations. A higher ratio of women to men in a given population signifies a relative abundance of same-sex mating competitors, intensifying female intrasexual competition. Five studies (N = 1,776) tested the hypotheses that women's perceptions of a female-skewed sex ratio would correspond to increased feelings of intrasexual competitiveness and perceptions of unfavorable mating prospects, which would, in turn, be associated with heightened body dissatisfaction and weight loss motivations. Among university and community women (Studies 1and 2), perceptions of a female-skewed sex ratio corresponded to greater intrasexual competitiveness, increased body dissatisfaction, and increased dieting inclinations. Among single women, assessments of a female-skewed sex ratio corresponded to perceptions of unfavorable mating prospects, increased romantic pressure to alter their appearance, and higher body dissatisfaction (Study 3). Studies 4 and 5 experimentally manipulated perceived sex ratio. Women in the female-skewed condition felt less satisfied with their weights and shapes, but only if they believed the manipulation (Study 4). In Study 5, using a within-subjects design, women who evaluated a male-skewed (vs. female-skewed) dating profile array subsequently desired to lose less weight. Findings suggest women's perceptions of their social environments may contribute to body image and dieting motivations.

Causal effects of appearance-related social exclusion on state body dissatisfaction among young Chinese adults

OBJECTIVES

Numerous studies have linked experiences of appearance-related interpersonal rejection to body dissatisfaction (BD), though few experimental studies have been conducted. This study assessed causal effects of appearance-related social exclusion during an online Cyberball game on state BD as well as potential moderators of this association.

METHODS

Young Chinese adults (60 women, 37 men; age 20.08 ± 1.32 years) were asked to provide an image of themselves that would be sent to other players prior to a visual perception study involving Cyberball, a virtual ball-tossing game that is used to elicit temporary social exclusion effects. Participants completed a trait Fear of Negative Appearance Evaluation (FNAE) measure before or after engaging in the Cyberball task in addition to post-task state measures of BD and positive mood facets.

RESULTS

Participants randomly assigned to the social exclusion condition (i.e., receiving 2 of 30 possible throws) reported significantly higher post-Cyberball state BD and significant happiness/energy level/self-confidence deficits compared to peers in a social inclusion condition (i.e., receiving 12 out of 30 throws). A hierarchical regression analysis indicated social exclusion condition membership and trait FNAE elevations, but not their interaction, were significant predictors of higher state BD scores, independent of the impact of gender.

CONCLUSIONS

Social exclusion experiences linked to physical appearance are a significant causal influence on increases in state BD and positive mood decrements among young Chinese adults.

TikTok Promotes Diet Culture and Negative Body Image Rhetoric: A Content Analysis

OBJECTIVE

This study aimed to explore the presence of body image and diet culture rhetoric in videos under the hashtag #HealthyLifestyle on TikTok.

METHODS

The top 250 videos under #HealthyLifestyle were categorized using a codebook of wellness topics. We conducted descriptive statistics and interrater reliability analysis.

RESULTS

#HealthyLifestyle videos had high rates of all coded categories, including negative and positive messages about body image and diet culture. Nearly all content with positive connotations was counteracted by coexisting negative messaging.

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that content under #HealthyLifestyle contains messaging conflicting with the definition of a healthy lifestyle. Considering the young audience consuming this content, improved nutrition education and health literacy in schools is essential.

The cost-effectiveness of a virtual intervention to prevent eating disorders in young women in Sweden

OBJECTIVE

To determine the cost-effectiveness of a virtual version of the Body Project (vBP), a cognitive dissonance-based program, to prevent eating disorders (ED) among young women with a subjective sense of body dissatisfaction in the Swedish context.

METHOD

A decision tree combined with a Markov model was developed to estimate the cost-effectiveness of the vBP in a clinical trial population of 149 young women (mean age 17 years) with body image concerns. Treatment effect was modeled using data from a trial investigating the effects of vBP compared to expressive writing (EW) and a do-nothing alternative. Population characteristics and intervention costs were sourced from the trial. Other parameters, including utilities, treatment costs for ED, and mortality were sourced from the literature. The model predicted the costs and quality-adjusted life years (QALYs) related to the prevention of incidence of ED in the modeled population until they reached 25 years of age. The study used both a cost-utility and return on investment (ROI) framework.

RESULTS

In total, vBP yielded lower costs and larger QALYs than the alternatives. The ROI analysis denoted a return of US $152 for every USD invested in vBP over 8 years against the do-nothing alternative and US $105 against EW.

DISCUSSION

vBP is likely to be cost-effective compared to both EW and a do-nothing alternative. The ROI from vBP is substantial and could be attractive information for decision makers for implementation of this intervention for young females at risk of developing ED.

PUBLIC SIGNIFICANCE

This study estimates that the vBP is cost-effective for the prevention of eating disorders among young women in the Swedish setting, and thus is a good investment of public resources.

Expanding upon the relationship between gender-affirming hormone therapy, neural connectivity, mental health, and body image dissatisfaction

OBJECTIVE

Transgender/non-binary (TNB) youth are at increased risk for anxiety, depression, and suicidality compared to cisgender youth. Gender affirming hormone therapy (GAHT, i.e., testosterone or estrogen) is a standard of care option for TNB youth, and we have recently shown that GAHT (testosterone) in transgender youth assigned a female sex at birth is associated with reductions in internalizing symptomatology. The current analysis explores: 1) whether these benefits are observed in both TNB youth assigned female at birth (TNBAFAB) and TNB youth assigned male at birth (TNBAMAB) and 2) the extent to which body image dissatisfaction and alteration in neural circuitry relate to internalizing symptoms.

METHOD

The current study is an expansion of a previous publication from our lab that explored the association between gender-affirming testosterone and internalizing symptomatology. While participants in our previous study consisted of 42 TNBAFAB youth, participants in the current study included adolescent TNBAFAB receiving GAHT (n = 21; GAHT+) and not receiving GAHT (n = 29; GAHT-) as well as adolescent GAHT+ TNBAMAB (n = 15) and GAHT- TNBAMAB (n = 17). Participants reported symptoms of trait and social anxiety, depression, suicidality in the past year, and body image dissatisfaction. Brain activation was measured during a face processing task designed to elicit amygdala activation during functional MRI.

RESULTS

GAHT+ TNBAFAB had significantly lower rates of social anxiety, depression, and suicidality compared to GAHT- TNBAFAB. While there were no significant relationships between estrogen and depression and anxiety symptoms, longer duration of estrogen was related to less suicidality. Both testosterone and estrogen administration were related to significantly lower rates of body image dissatisfaction compared to GAHT- youth. No significant differences emerged for BOLD response in the left or right amygdala during the face processing task, however, there was a significant main effect of GAHT on functional connectivity between the right amygdala and the ventromedial prefrontal cortex, such that GAHT+ youth had stronger co-activation between the two regions during the task. Body image dissatisfaction, greater functional connectivity, their interaction effect, and age predicted depression symptomatology and body image dissatisfaction additionally predicted suicidality in the past year.

CONCLUSION

The current study suggests that GAHT is associated with fewer short-term internalizing symptoms in TNBAFAB than in TNBAMAB, although internalizing symptoms among TNBAMAB may diminish with longer durations of estrogen treatment. Controlling for age and sex assigned at birth, our findings indicate that less body image dissatisfaction and greater functional connectivity between the amygdala and ventromedial prefrontal cortex were both predictors of fewer levels of internalizing symptoms following GAHT.