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Health impacts The adverse mental and physical health impacts of stigma are robustly documented and consistent across many different types of stigma, including due to eating disorders, weight, and other aspects of appearance. We encourage papers that enhance understanding of stigma in relation to eating disorders, weight, or body image, with strong interest in studies that include diverse samples, examine intersecting forms of stigma, or analyze stigma at multiple levels. We also invite papers that contribute new knowledge of how stigma affects health and well-being, and that move toward developing and implementing innovative interventions to prevent and reduce stigma for people with eating disorders and body image concerns. [Extracted from the article]

Background: Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. Method: A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. Findings: The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. Conclusions: The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN. Plain English summary: Anorexia Nervosa (AN) is a serious and life-threatening illness. There is a need to understand more about why AN persists in becoming severe and enduring (SE-AN) for some people. One such way to build understanding of a condition is via the stories of those who experience it. This study utilizes a person's unique artistic language to do so. This has the potential to generate new ideas about a condition, especially those that may be beyond words for some people and therefore progress classifications for SE-AN for research and treatment purposes. The artist in this study contributes a unique perspective offering new areas for potential research such as understudied complex psychological processes for example shame, dissociation, 'self', emotional literacy, and anorexia as an identity. Additionally, other factors to be considered in the assessment and classifications of long-term cases of AN as well as an alternative understanding of AN persistence is proposed, beyond the concept of 'body image disturbance'. Alternative treatment approaches such as art therapy are indicated. Note: Contents of this paper may be distressing to people who have lost a loved one to an eating disorder and the following website may provide access to support if any of the content of his paper causes the reader distress: USA - NEDA https://www.nationaleatingdisorders.org/ UK BEAT https://www.beateatingdisorders.org.uk/ Australia Butterfly https://butterfly.org.au/ or Lifeline - which is an international organisation with local websites. [ABSTRACT FROM AUTHOR]

Background: Social media content on Western platforms promoting thinness, or thinspiration, has been found to negatively affect body image perception of users. Less is known about non-Western social media use and its effects on body image concerns. Chinese TikTok, known as Douyin, is a popular short video platform with 600 million daily active users. Recent trends on Douyin encourage users to demonstrate thinness through participation in 'body challenges'. This paper argues that such content is comparable to thinspiration, however, to date hardly any research has been undertaken on these challenges. Thus, this pilot study aimed to analyse the content of three viral challenges and investigate their impact on Douyin users. Methods: Thirty most viewed videos were collected for three challenges (N = 90): the Coin challenge, the A4 Waist challenge, and the Spider leg challenge. Videos were coded for variables relating to thin idealisation, including thin praise, sexualisation and objectification, and analysed through content analytic methods. Video comments (N ≈ 5500) were analysed through thematic analysis, and main themes were identified. Results: Preliminary findings showed that participants who objectified their bodies to a greater extent expressed more negative body image concerns. In addition, comments on the videos had themes of thin praise, self-comparison, and promotion of dieting behaviours. In particular, videos of the A4 Waist challenge were found to incite more negative self-comparison in viewers. Conclusion: Preliminary findings suggest all three challenges promote the thin ideal and encourage body image concerns. Further research about the broader impact of body challenges is needed. [ABSTRACT FROM AUTHOR]

Background: Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. Methods: This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. Results: In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. Conclusions: Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary. Plain English Summary: A large proportion of individuals with eating disorders (ED) or ED symptomatology within the community do not seek treatment or professional help. Low rates of detection and early intervention, low treatment uptake, stigma, shame and lack of motivation to seek help can lead to significant physical and psychological impairment. Research has shown preventative and early intervention programs can significantly reduce ED risk factors, increase self-awareness and motivation to seek help and treatment. Greater allocation of time and resources is important to explore the long-term effectiveness and reach of these interventions within this population, to reduce the prevalence of EDs, particularly within individuals at a greater risk. To reduce the duration of untreated illness and increase treatment uptake, extensive efforts are needed to bridge the gap between early symptom recognition and timely access to evidence-based specialist services. [ABSTRACT FROM AUTHOR]

Background: Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. Methods: The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021–2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. Results: A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. Conclusion: Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals. Plain English summary: Research into the risk factors associated with eating disorders (EDs) is necessary in order to better understand the reasons why people develop EDs and to inform programs which aim to reduce these risk factors. In the current study we reviewed studies published between 2009 and 2021 which had researched risk factors associated with EDs. This study is one review of a wider Rapid Review series conducted as part the development of Australia's National Eating Disorders Research and Translation Strategy 2021–2031. The findings from this review are grouped into nine main risk factor categories. These include (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. Further research is needed to better understand the relationship between the risk factors, in particular the ways in which they may interact with each other and whether they cause the ED or are just associated with the ED. [ABSTRACT FROM AUTHOR]

Background: Several unsuccessful attempts have been made to reach a cross-disciplinary consensus on issues fundamental to the field of eating disorders in the United States (U.S.). In January 2020, 25 prominent clinicians, academicians, researchers, persons with lived experience, and thought leaders in the U.S. eating disorders community gathered at the Legacy of Hope Summit to try again. This paper articulates the points on which they reached a consensus. It also: (1) outlines strategies for implementing those recommendations; (2) identifies likely obstacles to their implementation; and (3) charts a course for successfully navigating and overcoming those challenges. Methods: Iterative and consensual processes were employed throughout the Summit and the development of this manuscript. Results: The conclusion of the Summit culminated in several consensus points, including: (1) Eating disorder outcomes and prevention efforts can be improved by implementing creative health education initiatives that focus on societal perceptions, early detection, and timely, effective intervention; (2) Such initiatives should be geared toward parents/guardians, families, other caretakers, and frontline healthcare providers in order to maximize impact; (3) Those afflicted with eating disorders, their loved ones, and the eating disorders community as a whole would benefit from greater accessibility to affordable, quality care, as well as greater transparency and accountability on the part of in-hospital, residential, and outpatient health care providers with respect to their qualifications, methodologies, and standardized outcomes; (4) Those with lived experience with eating disorders, their loved ones, health care providers, and the eating disorders community as a whole, also would benefit from the establishment and maintenance of treatment program accreditation, professional credentialing, and treatment type and levels of care guidelines; and (5) The establishment and implementation of effective, empirically/evidence-based standards of care requires research across a diverse range of populations, adequate private and government funding, and the free exchange of ideas and information among all who share a commitment to understanding, treating, and, ultimately, markedly diminishing the negative impact of eating disorders. Conclusions: Widespread uptake and implementation of these recommendations has the potential to unify and advance the eating disorders field and ultimately improve the lives of those affected. Plain English summary: A cross-disciplinary group of eating disorder professionals, thought leaders, and persons with lived experience have come together and reached a consensus on issues that are fundamental to the battle against the life-threatening and life-altering illnesses that are eating spectrum disorders. Those issues include: (1) the need for early detection, intervention, prevention, and evidenced-based standards of care; (2) the critical need to make specialized care more accessible and affordable to all those in need; (3) the importance of developing uniform, evidenced-based standards of care; (4) the need for funding and conducting eating spectrum disorder research; and (5) the indispensability of advocacy, education, and legislation where these illnesses are concerned. During the consensus process, the authors also arrived at strategies for implementing their recommendations, identified likely obstacles to their implementation, and charted a course for successfully navigating and overcoming those challenges. Above all else, the authors demonstrated that consensus in the field of eating spectrum disorders is possible and achievable and, in doing so, lit a torch of hope that is certain to light the path forward for years to come. [ABSTRACT FROM AUTHOR]

Background: The mass media promote certain standards of physical attractiveness. The media coverage, in interaction with body dissatisfaction and personality traits, may intensify specified behaviors in women, that should help them to obtain an ideal body image, e.g., excessive concentration on body image, weight control, increase in physical activity. The intensification of these behaviors can develop anorexia readiness syndrome (ARS) in women. The paper presents a study on the role of the Five-Factor Model personality traits (neuroticism, extraversion, agreeableness, conscientiousness, and intellect/openness), sociocultural factors (internalization, sociocultural pressure, information seeking), and body dissatisfaction in anorexia readiness syndrome. Methods: The study involved 1533 Polish women aged 18–36 (M = 22.51, SD = 2.41). The participants completed the online version of the set of questionnaires. The link to the study was shared in social media groups. Personality dimensions were measured with the BFI, sociocultural factors were evaluated by means of the SATAQ-3, the degree of body dissatisfaction was assessed with the BIQ, while ARS was measured using five self-reported items referring to specific behaviors from TIAE. Results: Hierarchical multiple regression analysis revealed internalization, sociocultural pressure, and body dissatisfaction as significant predictors of ARS. While neuroticism was correlated with ARS, it lost its predictive value after entering body dissatisfaction in the regression model. Conclusions: The factors associated with ARS were (1) neuroticism among personality traits, (2) internalization and pressure from sociocultural norms among sociocultural attitudes, and (3) body dissatisfaction. The key finding is the absence of statistical significance for neuroticism in predicting ARS after including body dissatisfaction. In future research, the group of men and patients with anorexia nervosa can be included, and the age range can be extended to include younger people. The catalog of potential ARS predictors may be expanded, which can help to explain the role of neuroticism in ARS. Plain English summary: Mass culture conveys a lot of information that women should use to fit the specific canon of beauty regarding the female body. Media body image standards can be absorbed by many women who may feel the pressure of having to conform to these standards. Adopting and adhering to the sociocultural ideals of beauty contributes to the development of body dissatisfaction as well as anorexia readiness syndrome (ARS) that can even lead to eating disorders under certain non-favorable circumstances in the long term. The aim of the study was to examine the contributing factors of ARS – thoughts, emotions and behaviors that may lead to diagnosable anorexia nervosa (AN). The study involved 1533 Polish women from a nonclinical population. Based on a review of the literature, possible determinants of ARS were selected: personality traits, sociocultural factors and degree of body dissatisfaction. Analyses confirmed that internalization and pressure from sociocultural norms (two sociocultural factors), and body dissatisfaction may help predict ARS. Neuroticism (personality trait) was also related to ARS. Knowledge of which factors may contribute to ARS may help in understanding how AN develops and what treatments may help prevent the illness from developing. In future research, it is also worth conducting the study on a group of patients with eating disorders and a group of men. Research on a more diverse group will help to understand the determinants of ARS. [ABSTRACT FROM AUTHOR]

The eating and feeding disorder section of the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR) is organized by a diagnostic algorithm that limits the contemporaneous assignment of multiple eating disorder diagnoses. Avoidant/restrictive food intake disorder (ARFID) is a disturbance in food intake typically associated with lack of interest in food, food avoidance based on sensory characteristics, and/or fear of aversive consequences from eating. According to the DSM-5-TR, an ARFID diagnosis cannot be made when weight or shape disturbances are present, and ARFID cannot be co-diagnosed with other eating disorders characterized by these disturbances. However, emerging evidence from both clinical and lived experience contexts suggests that the co-occurrence of ARFID with multiple other types of eating disorders may be problematically invisibilized by this trumping scheme. The diagnostic criteria for ARFID can contribute to inappropriate diagnosis or exclusion from diagnosis due to excessive ambiguity and disqualification based on body image disturbance and other eating disorder pathology, even if unrelated to the food restriction or avoidance. This harmfully limits the ability of diagnostic codes to accurately describe an individual's eating disorder symptomatology, impacting access to specialized and appropriate eating disorder care. Therefore, revision of the DSM-5-TR criteria for ARFID and removal of limitations on the diagnosis of ARFID concurrent to other full-syndrome eating disorders stands to improve identification, diagnosis, and support of the full spectrum of ARFID presentations. [ABSTRACT FROM AUTHOR]

This document is an abstract from the Journal of Eating Disorders, summarizing various research studies and presentations related to eating disorders. The studies cover topics such as the effectiveness of training programs for clinicians, the role of body image beliefs in eating disorder development, the intersection of eating disorders and fertility care, and the engagement of people with eating disorders in disability insurance schemes. Other studies explore the correlation between videoconferencing use and body image concerns, the use of embodiment illusions in treating mental disorders, and the mental health literacy of eating disorders among sport coaches. The article also discusses specific programs and interventions for eating disorders, the influence of parental comments on adolescents, and a digital learning platform called PeerED for peer workers in the eating disorder sector. Additionally, the document includes a systematic review of interventions for disordered eating in individuals with diabetes and a collection of abstracts covering various topics related to eating disorders and body image. [Extracted from the article]

Objective: To synthesise the evidence on the relationships between internalised weight bias (IWB) and biopsychosocial health outcomes in individuals ≤ 25 years. Methods: A systematic review was conducted by searching five scientific databases up to May 2022 to retrieve studies that investigated associations between IWB and biopsychosocial outcomes. Articles with participants ≤ 25 years, at least one validated measure of IWB, one measure of a biopsychosocial outcome, and were observational were included. Excluded articles involved systematic literature reviews, case study reports, intervention studies, meta-analyses, grey literature, pilot, and feasibility studies. Quality assessment was carried out using the American Dietetic Association Quality Criteria Checklist. The protocol was registered with PROSPERO, ID number CRD42022323876. Results: Two hundred and sixty-six articles were identified. Nineteen were eligible for inclusion, (15 cross-sectional and 4 prospective). The Weight Bias Internalization Scale and the Weight Self-Stigma Questionnaire were the most used tools to assess IWB with large heterogeneity in tool types used to assess biopsychosocial measures. IWB had positive associations with psychopathology, eating disorder symptomology, higher BMI, being female, and experiences of weight stigma. It was negatively associated with quality of life, body image, physical activity, social ability, self-esteem, and socioeconomic status. Discussion: IWB associated with adverse biopsychosocial outcomes in children and youth populations. IWB may be more clinically relevant in assessing at-risk children and youth than physical weight due to its psychosocial aspects and ability to expand beyond the scope of BMI. Research would benefit from better assessment tools designed for children and youth that accurately measure IWB. Future research should focus on increased diversity and longitudinal study designs with children and youth-specific populations. Plain English Summary: The objective of this systematic review was to bring together the current evidence on the relationship between internalised weight bias (IWB) and health outcomes in individuals under the age of 25. The systematic review was conducted by searching five scientific databases to retrieve studies that investigated associations between IWB and biopsychosocial outcomes. Two hundred and sixty-six articles were identified, with nineteen eligible for inclusion into the review. IWB was associated with increased mental illness, eating disorder symptoms, BMI, being female, and experiences of weight stigma. It was associated with a decreased quality of life, body image, physical activity, social ability, self-esteem, and socioeconomic status. Overall IWB was found to be associated with negative health and social outcomes in children and youth populations. Future research in this area should focus on increased diversity, longitudinal study designs and designing children and youth specific tools that accurately measure IWB. [ABSTRACT FROM AUTHOR]

Background: Both eating disorder (ED) prevention and weight management interventions often focus on the thin ideal. Yet, many Black and Latina women do not view thinness as their body ideal. This study used focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions. Methods: White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups. Results: Thematic analysis identified several themes, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming. Conclusions: Results suggested that current programs' emphasis on thinness limit their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for culturally responsive prevention. Plain English Summary: Both eating disorder (ED) prevention and weight management interventions often focus on thinness as the ideal. Yet, many Black and Latina women do not view thinness as their ideal body shape. This study interviewed women in focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions. White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups. Several themes emerged, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming. Results suggested that current interventions over-emphasize thinness, limiting their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for more culturally responsive approaches to prevention. [ABSTRACT FROM AUTHOR]

Background: Eating disorders (EDs) are a group of mental illnesses associated with significant psychological and physiological consequences. Overall, only about one-fifth of individuals with EDs receive treatment and treatment is effective for only about one-third for those who receive care. The development and implementation of effective prevention approaches for those at risk is therefore pivotal. The Body Project is the most effective ED prevention program for at-risk women according to several meta-analyses, but reach is limited since delivery, traditionally, has been in-person. Moreover, peer-led Body Project groups have been reported to produce stronger effects than clinician-led Body Project groups when delivered in-person. This has not yet been examined for virtually delivered Body Project groups. This study therefore seeks to investigate the effect of virtual Body Project groups delivered by peers versus clinicians on ED risk factors, ED symptoms, and prospective ED onset. Methods: Young women with body image concerns aged 16–25 years (N = 441) will be included in the study and randomized to three conditions: (i) virtually delivered Body Project groups led by clinicians; (ii) virtually delivered Body Project groups led by peers; and (iii) psychoeducational control group. Participants will complete assessments at five timepoints over two years (pretest, posttest, 6-months, 1-year, and 2-years). Discussion: Further research is needed to examine approaches to increase the potential for broad implementation of prevention of EDs. The virtual modality of the Body Project could markedly expand the reach for young women at risk. If findings confirm that peers can deliver virtual Body Project groups as effectively as clinicians, this will further enhance the implementation potential. Trial registration: The present study has been registered on clinicaltrials.gov (NCT05993728). [ABSTRACT FROM AUTHOR]

Introduction: The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-oriented body dissatisfaction in research and clinical practice. However, no validated Arabic version of this scale exists to date. In this study, we sought to validate this instrument in three samples of native Arabic-speaking adolescents, adults, and pregnant women from Lebanon. Methods: A total of 826 adults, 555 adolescents, and 433 pregnant women were included. To examine the factor structure of the BDS, we performed an exploratory factor analysis (EFA), using a principal component analysis via the FACTOR software on the first split-half subsample among Lebanese adults. We used data from the second split-half in the adult sample to conduct a Confirmatory Factor Analysis (CFA) through the SPSS AMOS v.29 software. That verified model was tested via CFA on adolescents and pregnant women. Results: The EFA showed a bidimensional structure for the BDS, with all 9 items retained and divided into Factor 1 = Body Satisfaction (negatively-worded items) and Factor 2 = Body Dissatisfaction (positively-worded items). The CFA demonstrated invariable goodness-of-fit of the instrument in the three studied populations. McDonald's omega values were also adequate in the three samples, demonstrating its reliability. Moreover, the BDS showed invariance across sex among both adolescents and adults. Finally, higher BDS scores were correlated with more disordered eating, less body appreciation and less functionality appreciation, thus attesting to convergent validity of the scale. In addition, BDS scores correlated positively with depression and anxiety scores, indicating adequate patterns of divergent validity. Conclusion: In light of our findings, we endorse the use of the BDS by healthcare professionals in Arabic-speaking countries, in order to assess thinness-oriented body dissatisfaction in an appropriate and timely manner and ease early referral to a specialist, thereby preventing the deleterious health-related risks associated with this condition. Plain English Summary: Body dissatisfaction is conceptualized as the pejorative subjective assessment of one's own body and discontent with the visual perception of it or with a particular feature of appearance, which is considered to be the most important global measure of stress related to the body. Body dissatisfaction has been found to be a predictor for the development of an eating disorder and occurs in individuals with different mental disorders. The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-focused body dissatisfaction, but has not yet been validated in Arabic. To this end, we aimed to translate and validate the Arabic version of the BDS in the present study, which would in turn facilitate research and improve clinical practices related to body dissatisfaction in Arabic-speaking nations. The present findings provide support for the psychometric properties of the Arabic version of the BDS for examining body dissatisfaction in Arabic-speaking adolescents, adults, and pregnant women in Lebanon. [ABSTRACT FROM AUTHOR]

Background: Understanding the formation of body image is critical for the prevention and treatment of eating disorders, especially in adolescence, when body image develops significantly. One of the important facets of body image is body appreciation, which consists of positive feelings and attitudes towards the body regardless of its perceived "flaws". To measure body appreciation, Body Appreciation Scale-2 (Tylka and Wood-Barcalow in Body Image 12:53–67, 2015a), a unidimensional 10-item measure, has been developed and routinely used in body image research. The current study examined the validity (i.e., factor structure, gender and age invariance, associations with other constructs) of the Czech version of Body Appreciation Scale-2 for adolescents. Methods: The study used two large samples of Czech adolescents, aged 13–18 (N1 = 613, M = 15.5, 52% girls; N2 = 1,530, M = 15.4, 50% girls). The data were collected in August 2021 (N1) and November 2020 (N2) through an online survey. For the data analysis, we used confirmatory factor analysis (CFA), multi-group confirmatory factor analysis (MG-CFA), and Structural Equation Modeling (SEM). Results: Our findings supported the proposed unidimensional factor structure and the gender (i.e., girls, boys) and age (i.e., 13–15, 16–18) scalar invariance of the Czech version of Body Appreciation Scale-2. The data also showed the expected positive correlations with body satisfaction and self-esteem, and negative correlations with media-ideal internalization, appearance schematicity, and depression. Furthermore, we discovered that body appreciation was more strongly connected to media-ideal internalization and depression for girls than boys. Conclusions: The present study provided robust evidence that supports the validity of the Czech version of Body Appreciation Scale-2 and its usability for the assessment of body appreciation in Czech adolescents. We also proposed future directions for the research on body appreciation based on the explored gender differences. Plain English Summary: Understanding the formation of body image—that is, how people view and evaluate their bodies—is crucial for the prevention and treatment of eating disorders. This is especially true in adolescence, when body image develops significantly. That being said, the psychological assessment of body image, both in research and practice, requires reliable, high-quality measurement scales. Since its development by Tylka and Wood-Barcalow (2015a), Body Appreciation Scale-2 has been routinely used to assess body appreciation, which includes positive attitudes towards one's body despite its perceived "flaws". Our study provides evidence for the quality of the Czech version of Body Appreciation Scale-2 for use with adolescents. We examined the scale's characteristics on data from two robust samples (613 and 1530 Czech adolescents). Our study showed that the qualities of Czech Body Appreciation Scale-2 are satisfactory, and we recommend the scale for the assessment of body appreciation for adolescents in the Czech context. We also documented that the scale scores can be accurately compared between adolescent girls and boys, and younger (13–15) and older (16–18) adolescents. Additionally, we discovered gender differences in the relationships between body appreciation and depressive moods and the internalization of media ideals, which demands further exploration in future research. [ABSTRACT FROM AUTHOR]

Abstract Background Social media content on Western platforms promoting thinness, or thinspiration, has been found to negatively affect body image perception of users. Less is known about non-Western social media use and its effects on body image concerns. Chinese TikTok, known as Douyin, is a popular short video platform with 600 million daily active users. Recent trends on Douyin encourage users to demonstrate thinness through participation in ‘body challenges’. This paper argues that such content is comparable to thinspiration, however, to date hardly any research has been undertaken on these challenges. Thus, this pilot study aimed to analyse the content of three viral challenges and investigate their impact on Douyin users. Methods Thirty most viewed videos were collected for three challenges (N = 90): the Coin challenge, the A4 Waist challenge, and the Spider leg challenge. Videos were coded for variables relating to thin idealisation, including thin praise, sexualisation and objectification, and analysed through content analytic methods. Video comments (N ≈ 5500) were analysed through thematic analysis, and main themes were identified. Results Preliminary findings showed that participants who objectified their bodies to a greater extent expressed more negative body image concerns. In addition, comments on the videos had themes of thin praise, self-comparison, and promotion of dieting behaviours. In particular, videos of the A4 Waist challenge were found to incite more negative self-comparison in viewers. Conclusion Preliminary findings suggest all three challenges promote the thin ideal and encourage body image concerns. Further research about the broader impact of body challenges is needed.

Background: Transgender and nonbinary (TGNB) adolescents and young adults are underrepresented in the literature on eating disorders and body image-related problems, despite increased mental health disparities and emerging research showing high associations between gender dysphoria, body image, and eating disorders among TGNB youth. Aims: The scoping review was designed to critically examine the research on TGNB adolescents and young adults who experience eating and body image related problems as well as clinical studies on treatment approaches and effectiveness. Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used for reporting this scoping review. The electronic databases of MEDLINE and PsychInfo were used for searching subject terms. Inclusion criteria for studies required the quantitative measurement or qualitative exploration of body image or eating for transgender minor children, adolescents, or young adult samples (18 to 25 years old) and address differences in eating/body-related problems by age. The relevant data was extracted and narratively summarized. Results: 49 studies were identified, data extracted, and analyzed. Increased prevalence of eating disorders and body image problems were identified for TGNB youth. Body-gender congruence through gender affirming social and medical interventions (e.g., hormone therapy) were noted as significant for alleviating body image problems and facilitating eating disorder treatment. Family and social factors were not well understood in the literature and a need for increased study of TGNB youth from varied racial/ethnic, neurodiverse, and within specific identities (e.g., nonbinary) and families and cultural contexts is still needed. Conclusions: Future research should consider the use of developmental and family theories for guiding inclusion of salient social factors influencing eating patterns, body image, and treatment outcomes. In addition, more studies are needed with those from minoritized racial and ethnic groups, neurodiversity, and varied gender identities (e.g., nonbinary and gender queer) for identifying important differences. Plain English summary: Forty-nine published research studies with transgender and nonbinary (TGNB) adolescents and young adults on eating patterns and body image were identified, summarized, and critically examined. Eating disorders and body image problems are more prevalent with TGNB adolescents and young adults, as compared to their non-transgender peers. More research is needed TGNB minor children, adolescents, and young adults as separate groups and as part of family and social settings where they may experience rejection and delays in seeking and accessing treatment. [ABSTRACT FROM AUTHOR]

Objectives: The present study sought to examine the factor structure, reliability, validity and gender invariance of the Arabic Body Appreciation Scale (BAS-2), and its two short forms (the 3-item and 2-item BAS-2SF) among community Lebanese Arabic-speaking adults. Methods: We carried-out an online cross-sectional survey. The 10-item BAS-2, the functionality appreciation scale and the Eating Attitudes Test-26 were completed by 826 Lebanese community adults (57.9% females, aged 25.42 ± 8.44 years). Results: The Arabic 10-item, 3-item and 2-item BAS-2 converged on a one-factor solution, and demonstrated high internal consistency (McDonald's ω value of.92,.88, and.86 respectively). All indices suggested that configural, metric, and scalar invariance was supported across gender. The 3-item and 2-item BAS-2SF were highly correlated with the original BAS-2 (r > 0.9). Higher 10-item, 3-item and 2-item BAS-2 scores correlated significantly and strongly with more positive eating attitudes and greater functionality appreciation, and higher 10-item BAS-2 scores correlated positively and weakly with BMI, supporting convergent validity. Conclusion: The present work contributes to the literature by providing a psychometrically sound Arabic-translation of the BAS-2 and short-forms, benefitting both researchers and clinicians. Plain English Summary: Research on body image traditionally has focused on describing and predicting negative body image such as body dissatisfaction, body shame, and body preoccupation, with less focus on identifying, predicting, and promoting adaptive body attitude. Recently, however, the study of positive body image has gained considerable motion, and body appreciation has been the central organizing variable within these investigations. Body appreciation has been defined as accepting, holding favourable opinions toward, and respecting the body, while also rejecting media-promoted appearance ideals as the only form of human beauty. The Body Appreciation Scale has been utilized by researchers to understand features, correlates, and potential outcomes of positive body image. This scale and its short forms are not yet validated in Arabic. To that end, we aimed to translate and validate the Arabic version of the Body Appreciation Scale (BAS-2), and its two short forms (the 3-item and 2-item BAS-2SF) in the present study, which would in turn facilitate improved research and clinical practices related to body appreciation in Arabic-speaking nations. The present findings provide support for the psychometric properties of the Body Appreciation scales in Arabic-speaking adults in Lebanon. [ABSTRACT FROM AUTHOR]

Background: Exercise addiction (EA) and eating disorders (ED) frequently co-occur in both professional and amateur athletes, with up to 48% of individuals with EA also exhibiting symptoms of ED. Furthermore, pathological attachment styles have been linked to both EA and ED. The current study aimed to explore the unique association between types of insecure attachment styles (i.e., anxiety or avoidance) and EA and ED. Method: Four hundred and five Israelis (199 women, 206 men) who were recreational exercisers (i.e., exercised at least four hours a week for at least one year) with ages ranging from 18 to 78 (M = 38, SD = 12.31) completed a set of questionnaires, including the Eating Attitudes Test (EAT-26), Exercise Addiction Inventory, and the Experiences in Close Relationship Scale. Path analysis was used to simultaneously examine the associations of attachment anxiety and avoidance with EA and ED symptoms. Attachment anxiety and avoidance were specified as independent variables predicting ED and EA symptoms and were entered into the analysis as two parallel dependent variables. Results: The results of the study indicate that attachment anxiety is positively associated with symptoms of EDs, while the association between attachment anxiety and symptoms of EA is not significant. On the other hand, attachment avoidance shows a positive association with symptoms of exercise addiction, but no significant association with symptoms of EDs is found. Conclusions: These results imply that the anxious attachment regulation strategy is highly associated with body image concerns. Furthermore, individuals characterized by avoidance attachment manifest regulation strategies through excessive exercise. Scholars and practitioners could use these results to examine dispositional risk factors for insecure attachment styles and to assess specific pathologies among the population of recreational exercisers. The study also discusses limitations, future directions, and implications in detail. Plain English summary: The present study aimed to investigate the relationship between exercise addiction, eating disorders, and pathological attachment styles among habitual exercisers. Approximately half of individuals addicted to exercise also exhibit maladaptive eating behaviors. Insecure attachment styles have been associated with these two pathologies. However, the exact nature of this relationship is not fully understood and requires further research. A total of 405 habitual athletes who exercised for a minimum of four hours per week for at least one year were recruited from social media groups dedicated to exercise, as well as through ads posted at fitness centers and with professional trainers. Participants completed three psychological inventories, including measures of eating disorder symptoms, exercise addiction, and attachment styles. Results indicated that attachment anxiety was solely related to symptoms of maladaptive eating behaviors, while attachment avoidance was only associated with symptoms of exercise addiction. Findings suggest that individuals with anxious attachment may be more prone to body image concerns, whereas those with avoidance attachment may be more likely to engage in compulsive exercise behaviors. These results have implications for scholars and practitioners in terms of examining dispositional risk factors for insecure attachment styles and assessing specific pathological and addictive behaviors among recreational exercisers. [ABSTRACT FROM AUTHOR]

Background: Eating disorder treatment approaches and outcome studies have historically centered almost exclusively on cisgender populations. Transgender and nonbinary (TGNB) adults are underrepresented in general and intervention research despite being at increased risk for eating and body image-related problems. Aims: This scoping review was designed to gather and examine the research with TGNB adults who experience eating and body image related problems, as well as clinical studies on the effectiveness of treatment approaches. Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used for reporting this review. MEDLINE and PsychInfo were used as electronic databases for searching subject terms. Inclusion criteria for studies required the quantitative measurement or qualitative exploration of body image or eating for TGNB adults. The relevant data were extracted and summarized based on quantitative findings and qualitative themes. Results: After review of over 1258 articles, 59 studies met criteria and data were extracted and summarized. Factors associated with eating disorders and body image problems across studies suggests gender-affirming medical interventions are effective and emphasized treatment for an eating disorder is warranted alongside gender affirming medical care. Body image was associated with eating patterns aimed at meeting gendered ideals of body shape and size. There was variation in guiding theories and absence of consensus in the definition of transgender in the review studies. This likely demonstrates the changing language, social acceptance of TGNB people and identities, diagnostic criteria, and clinical conceptualizations of eating and body image. Conclusions: Future research should consider the use of theory for guiding inclusion of salient social factors influencing eating patterns, body image, and treatment outcomes. In addition, future research is needed that centers on nonbinary and genderqueer populations, as well as those from minoritized racial and ethnic groups to inform culturally appropriate concerns, needs, and treatment modalities. Plain English Summary: Fifty-nine published research studies with transgender adults on eating patterns, body image, and associated risks and comorbidities were collected and summarized. Across studies, gender affirming medical interventions like hormone therapy and surgery were associated with decreases in eating disorder symptoms and improved body image. Studies from interviews with transgender adults found social causes for disordered eating and poor body image including rejection and discrimination. Future studies should use guiding theories for testing the causality and consider rejection and discrimination experienced by transgender adults. [ABSTRACT FROM AUTHOR]

Background: Functionality appreciation, as an important aspect of positive image, is associated with fewer body image disturbances, fewer disordered eating behaviors, and improved psychological well-being. However, it has been under-researched in Asian countries. The current work aimed to examine the psychometric properties of the Functionality Appreciation Scale (FAS) among four Chinese samples of different ages, and further examine measurement invariance and differences of the FAS across gender and age groups. Methods: Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to examine the factorial structure of the FAS among four Chinese samples of different ages, including middle school adolescents (n = 894, Mage = 12.17 years), high school adolescents (n = 1347, Mage = 15.07 years), young adults (n = 473, Mage = 21.95 years), and older adults (n = 313, Mage = 67.90 years). The measurement invariance of the FAS across gender and age was examined. Internal consistency reliability and construct validity were evaluated. Results: The FAS had a unidimensional structure and was invariant across gender and age groups. The FAS presented sound psychometric properties in all age groups by gender, with good internal consistency reliability [e.g., high Cronbach's α values (.91 ~.97)] and good construct validity (e.g., significant associations with body appreciation, body dissatisfaction, and disordered eating). Moreover, group comparisons showed minimal gender differences in functionality appreciation. However, significant age differences were found in functionality appreciation, with older ages generally associated with higher functionality appreciation. Conclusion: Overall, findings suggest that the FAS is a sound instrument to be used in the Chinese context. Furthermore, functionality appreciation was found to be higher in older adults than adolescents or young adults, suggesting the potential important role of aging in functionality appreciation. Plain English summary: Functionality appreciation, as a positive body image component emphasizing the appreciation on one's body for what it can do, is associated with fewer body image disturbances, fewer disordered eating behaviors, and improved psychological well-being. The Functionality Appreciation Scale (FAS) measures functionality appreciation and has been widely validated in a number of different populations. However, the psychometric properties of the FAS have not been systematically examined in the Chinese context, especially for adolescents and older adults. Results indicated that the psychometric properties of the FAS were sound and could be equally used to assess functionality appreciation in Chinese adolescents, young adults, and older adults. [ABSTRACT FROM AUTHOR]

Background: Little research has investigated the harmful effects of old talk—negative age-related body talk—on mental health and quality of life despite substantial research examining fat talk. Old talk also has only been evaluated in women and in relation to few outcomes. Of note, old talk and fat talk are strongly correlated, suggesting possible overlap in elements that drive negative outcomes. Thus, the primary aim of this study was to investigate the extent that old talk and fat talk contribute to negative mental health and quality of life outcomes when examined in the same model and when interacting with age. Methods: Adults (N = 773) ages 18–91 completed an online survey assessing eating disorder pathology, body dissatisfaction, depression, aging anxiety, general anxiety, quality of life, and demographics. Results: While fat talk and old talk were correlated with almost all outcome variables, fat talk was more commonly significantly associated with poorer outcomes than old talk. Additionally, the relationship between fat talk and old talk with poorer mental health was affected by age in men, but not women. Conclusions: Future research is warranted to decipher the individual effects of old talk and fat talk on mental health and quality of life across the adult lifespan. Plain English summary: The term "negative body talk" is used to describe the negative things people sometimes say about their bodies and appearance. Two kinds of negative body talk are fat talk (critical and negative talk about weight-related body image) and old talk (negative body talk focused on changes due to aging). Fat talk has been widely studied and found to be related to poorer mental health, including body dissatisfaction and eating disorders. However, old talk has been much less studied though it is both similar and distinct from fat talk. The current study examined how both old talk and fat talk related to mental health and quality of life in adults across the lifespan. We found that both were correlated with poorer mental health, but when compared to one another, fat talk was more related to mental health in both men and women. Of note, age appears to impact these relationships in men, but not in women. It is important for future research to examine why age seems to influence the impact old talk and fat talk have on mental health and further evaluate the similarities and differences between these two types of negative body talk. [ABSTRACT FROM AUTHOR]

Background: The prevention and treatment of eating disorders relies on an extensive body of research that includes various foci and methodologies. This scoping review identified relevant studies of eating disorders, body image, and disordered eating with New Zealand samples; charted the methodologies, sample characteristics, and findings reported; and identified several gaps that should be addressed by further research. Methods: Using scoping review methodology, two databases were searched for studies examining eating disorders, disordered eating, or body image with New Zealand samples. Snowball methods were further used to identify additional relevant articles that did not appear in initial searches. Two independent reviewers screened the titles and abstracts of 473 records. Full text assessment of the remaining 251 records resulted in 148 peer-reviewed articles being identified as eligible for the final review. A search of institutional databases yielded 106 Masters and Doctoral theses for assessment, with a total of 47 theses being identified as eligible for the final review. The included studies were classified by methodology, and the extracted information included the study foci, data collected, sample size, demographic information, and key findings. Results: The eligible studies examined a variety of eating disorder categories including binge-eating disorder, bulimia nervosa, and anorexia nervosa, in addition to disordered eating behaviours and body image in nonclinical or community samples. Methodologies included treatment trials, secondary analysis of existing datasets, non-treatment experimental interventions, cross-sectional observation, case-control studies, qualitative and mixed-methods studies, and case studies or series. Across all of the studies, questionnaire and interview data were most commonly utilised. A wide range of sample sizes were evident, and studies often reported all-female or mostly-female participants, with minimal inclusion of males and gender minorities. There was also an underrepresentation of minority ethnicities in many studies, highlighting the need for future research to increase diversity within samples. Conclusion: This study provides a comprehensive and detailed overview of research into eating disorders and body image in New Zealand, while highlighting important considerations for both local and international research. Plain English summary: Research into eating disorders should include different methods, and should be relevant to people of different ages, gender identities, and ethnicities. We completed a scoping review of research into eating disorders, disordered eating, and body image in New Zealand samples. We searched academic databases for relevant articles, and then screened the articles for eligibility. We then hand-searched key articles, and searched databases again using the names of key authors. A total of 148 peer reviewed articles and 47 theses were eligible for the review, and from these we extracted data on the study method, sample characteristics, and the focus and results. A wide range of methods and sample sizes were reported, and the studies explored several different eating disorders, as well as disordered eating and body image in nonclinical samples. However, the studies often involved all or mostly female samples, few to no gender minority participants, and an underrepresentation of minority ethnicities. Funders should provide adequate time and financial resources to fund recruitment from historically under-represented groups, emphasising their involvement as active researchers. In addition, funders should consider financing the use of novel or underutilised methods to advance knowledge in this field. [ABSTRACT FROM AUTHOR]

Background: Body appreciation might serve as a protective factor for developing eating disorders and is associated with participation in physical activity. Less is known about whether various arenas for physical activity may be linked to body appreciation. Therefore, the current study sought to (1) identify potential associations between physical activity level and arenas for physical activity, connectedness with nature, self-compassion, and body appreciation in adults, and (2) explore physical activity level and arenas, connectedness with nature, and self-compassion as explanatory factors for body appreciation. Methods: A total of 360 adult Norwegian inhabitants (75% women, mean (SD) age 42.58 (12.30) yrs) responded to an online questionnaire. Instruments included the Body Appreciation Scale, the Connectedness with Nature Scale, and the Self-Compassion Scale. Results: The percentage of participants who engaged in various physical activity arenas were 98.5% for nature, 57.5% for fitness centers, and 43.0% for organized sports. Small, positive associations were found between body appreciation and the frequency of using fitness centers and nature as physical activity arenas. Self-compassion, connectedness with nature, and frequency of using fitness centers and nature as physical activity arenas explained 39% of the variance in body appreciation. Discussion: The importance of both fitness centers and nature as arenas for physical activity to explain body appreciation was surprising and might reflect different use of fitness centers among adults compared to younger age groups. Conclusion: Physical activity at fitness centers and in nature were positively associated with body appreciation in adults. Self-compassion, connectedness with nature, and using fitness centers and nature as arenas for physical activity, were found to explain variation in body appreciation in adults. Plain English summary: Physical activity helps us feel good about ourselves and appreciate our bodies. However, less is known about the extent to which different arenas for physical activity are related to body appreciation. Therefore, 360 adults from Norway completed a survey with questions about their physical activity level, use of nature, fitness centers, and organized sports as arenas for physical activity, and measures linked to connectedness with nature, self-compassion, and body appreciation. We found an association between body appreciation and performing physical activity at fitness centers and in nature. Physical activity at these two arenas together with self-compassion and connectedness with nature explained body appreciation in these adults. Future studies should focus on the adolescent population, where the level of body appreciation tend to be lower and where organized sports, in addition to fitness centers, constitute an even more commonly used physical activity arena. [ABSTRACT FROM AUTHOR]

Background: Current research on muscle dysmorphia (MD) has focused on restrained eating behaviors and has adopted a primarily male perspective. Despite initial evidence, the role of possible binge eating associated with MD has only been scarcely investigated. To extend the transdiagnostic and cross-gender approaches and address the dearth in research related to MD, this study investigated the association between MD psychopathology and binge eating in men and women. Methods: This study investigated the association between MD psychopathology and binge eating in both men and women. Participants were a sample of 5905 men (n = 422) and women (n = 5483) social media users aged 18–72 years. They completed an online survey that included self-report measures assessing demographics, binge eating, MD psychopathology, and drive for thinness and leanness. Binge eating was assessed using the diagnostic questions of the validated German version of the Eating Disorder Examination-Questionnaire. The Muscle Dysmorphic Disorder Inventory (MDDI) was used to assess MD psychopathology. A total score of > 39 was set as a cutoff to define an "MD at-risk" state for both men and women. Hierarchical logistic regression analysis was used to analyze the association between MD psychopathology and binge eating. Results: MD psychopathology was significantly positively associated with binge eating in both men and women. Among the three MDDI subscales, only appearance intolerance was significantly associated with MD, and drive for size and functional impairment were not associated. MD at-risk status yielded a predicted probability of binge eating of 25% for men and 66.9% for women. The increased probability of binge eating associated with MD at-risk status was mainly accounted for by appearance intolerance in men and drive for thinness in women. Conclusion: MD psychopathology is positively associated with binge eating in both men and women. Binge eating episodes should therefore form part of the clinical assessment of MD. Plain English summary: Muscle dysmorphia is a mental disorder in which those affected are constantly preoccupied with being insufficiently muscular. Although there is initial evidence that binge eating may play a role in the clinical presentation of muscle dysmorphia (MD), this has not been investigated. In addition, MD has rarely been studied in women. We conducted a study involving 5905 men (n = 422) and women (n = 5483) using self-report questionnaires to examine the association between binge eating and symptoms of MD. We found that symptoms of MD and binge eating are positively associated. According to our model, two-thirds of women and one-quarter of men at-risk for MD exhibit binge eating. Binge eating episodes should therefore form part of the clinical assessment of MD. [ABSTRACT FROM AUTHOR]

Background: 'Classic' embodiment illusions (e.g., the feeling of owning another person's hand) involves a three-way interaction between visual, proprioceptive, and tactile stimuli. These illusions have been studied in eating disorder (ED) populations given the potential implications for better understanding and improving body image concerns. Recently, several studies have employed 'tactile-reduced' methods mainly relying on the integration of visual and proprioceptive information to induce embodiment illusions in non-ED populations. To date, there has been no substantial review of these tactile-reduced approaches to consider their potential research and clinical utility in ED populations. Method: This review sought to examine and integrate studies across three areas. Firstly, those that employed tactile-reduced embodiment techniques in non-ED populations. Secondly, those that used classic embodiment techniques to compare whether ED and non-ED populations differ in their susceptibility to embodiment. Thirdly, studies that investigated whether experiencing classic or tactile-reduced embodiment techniques can improve image-related concerns. Results: For the first aim five studies were identified, all of which found that tactile-reduced methods consistently induced embodiment illusions in non-ED individuals. For the second aim, seven studies comparing ED and non-ED samples were found. ED patients were more susceptible to embodiment than non-ED samples in four studies, less susceptible in one study, and equally susceptible in two studies. Finally, for aim three, amongst the seven studies that used classic or tactile-reduced embodiment methods in ED populations, six reported improvements in self-perception (i.e., reduced body size overestimation, decreased body dissatisfaction and fear of gaining weight). Conclusions: Along with the classic approach, tactile-reduced embodiment approaches have implications for ED research and clinical practice, particularly for situations when face-to-face contact with people are restricted. Suggestions are provided for future researchers who wish to ensure best practice for planning embodiment research involving classic and tactile-reduced approaches. Plain English summary: Embodiment illusions involve the temporary experience of owning another person's body or body parts. These illusions have been studied in people with eating disorders (EDs) as a means for (i) better understanding their self-perception issues (e.g., they tend to see their own appearance as being too big), and (ii) improving these self-perception issues (i.e., does experiencing embodiment reduce distortions involving body size?). 'Classic' embodiment illusions typically require participants to simultaneously experience visual, proprioceptive, and tactile sensory stimulation. However, COVID -19 pandemic restrictions have limited research in face-to-face settings which poses a challenge for the classic approach, mainly in relation to tactile input which would usually be provided by a researcher. A 'tactile-reduced' approach for eliciting embodiment illusions would, therefore, enable this field of research to continue, which in turn may benefit people with EDs. While several studies in non-clinical populations have demonstrated the effectiveness of a tactile-reduced approach, understanding surrounding this approach in ED populations is lacking. In this review, we offer a prospective set of suggestions regarding how tactile-reduced embodiment may be conducted with ED populations, both in terms of better understanding their (problematic) self-perception, and how such concerns may be improved. [ABSTRACT FROM AUTHOR]

Background: Characterised by the belief that more weight needs to be lost—despite emaciation, failing organs, medical instability and prospect of death—Anorexia Nervosa (AN) is a condition in which irrational, and highly-skewed, beliefs can be of delusional intensity. However, the nexus between delusion and rational awareness and how this is related to body image acceptance and perception has yet to be examined in AN. The current study aims to investigate the relationship between body dissatisfaction and beliefs of delusional intensity in an adult AN inpatient sample. Methods: Twenty-one adults (n(women) = 20; n(men) = 1), with a mean age of 27 years old (SD = 10), presenting for inpatient treatment for AN (ranging in severity from mild to severe; M(Body Mass Index) = 17 kg/m2; M(Length of Stay) = 22 days) participated in the study. Participants' dominant beliefs (related to AN) and level of insight (delusional; overvalued idea; or fair insight) were measured using either the Brown Assessment of Beliefs Scale (BABS) or the Nepean Beliefs Scale (NBS). The degree of body dissatisfaction was determined by examining the discrepancy between "perceived" and "ideal" body perception. To determine subjective and objective beliefs both the Contour Drawing Rating Scale (subjective) and computerised Body Image Assessment Software (objective) were used. Results: Almost one quarter (23.7%; n = 5) of participants appeared to have beliefs of delusional intensity related to their body shape (M = 27.4; SD = 23.03). Although a positive linear trend was indicated, there were no significant differences in body dissatisfaction scores between level-of-insight. Individuals whose belief was categorised as delusional were more likely to hold a negative affective body image state based on their ratings on the body image state survey when compared to the group who had good/fair insight (95% CI [0.53, 18.19]; p = 0.03). Conclusions: The current exploratory pilot study concurs with others in the published literature that demonstrate that approximately 25 percent of participants with AN may have delusional ideas. The implications for treatment in similar samples warrant attention. Future research should also seek to understand the clinical significance of this delusional categorisation, the benefits of its utility in this population, and its relation to the severity of AN or stage of illness. Plain English Summary: Anorexia Nervosa (AN) is notable for the individual's conviction that they need to lose weight—even when they are dangerously underweight- or to prevent weight gain. However, how these beliefs relate to the emotional experience of the body, in the presence of AN need to be explored further. This study begins to examine this relationship. Twenty-one adults (95% women; average age 27 years) receiving in-patient treatment for AN were asked a series of questions related to beliefs about their body. To allow a comparison between the level-of-insight and body shape dissatisfaction, participants were also asked to rate how satisfied or dissatisfied they were about their body shape. Almost 25% of the sample had beliefs of delusional intensity about their body shape. Further, it was also found that people with AN who had stronger beliefs of delusional intensity were more likely to be dissatisfied with their body shape. This pilot study appears to support previous research that suggests that some individuals with AN have stronger beliefs of delusional intensity. The findings from the current study should be extended with future research looking at the impact of beliefs on illness and treatment. [ABSTRACT FROM AUTHOR]

Background: Negative body image is a common psychological phenomenon among Chinese college students meriting investigation. Peers and the media are important factors that negatively influence body image. This study explored the mechanisms of media and peers promoting negative body image among Chinese college students. Method: Data from 407 college students (173 men and 234 women) were collected using the Revised Social and Cultural Attitude Questionnaire of Appearance, Appearance Comparison Scale, Peer Impact Scale, and Negative Body Image Scale. Results: Correlational analysis results demonstrated that media attention was not significantly correlated with negative body image. All other variables were significantly positively correlated. Path analysis results indicated that the direct effect of media attention on negative body image was not significant, while the direct effect of peer impact was significant. In addition, appearance comparison and internalization of the thin ideal acted as a chained indirect effect between negative body image, media attention, and peer impact. Conclusions: The research revealed that focusing on perfect bodies displayed in the media did not produce a negative body image. However, focusing on the media and peer conversations regarding the body caused the participants to compare appearances and internalize ideal body shape standards, leading to negative self-evaluations. Plain English Summary: Adolescents' peers and media have far-reaching influence. This study explored their impact on the body image of Chinese college students. A questionnaire survey was distributed to 461 Chinese college students. The results showed that peers directly affected body image, while media attention did not. Media attention and peer impact further increased students' negative body image evaluations through the indirect effects of appearance comparison and internalization of the thin ideal. [ABSTRACT FROM AUTHOR]

Background: Disordered eating behaviour (DEB) represents a significant morbidity among people with type-1 diabetes (T1D). Continuous-subcutaneous insulin infusion (CSII) improves glycemic control and psychological wellbeing in those with T1D. However, its relation to DEB remains obscure. Objectives: To compare DEB among adolescents with T1D on CSII versus basal-bolus regimen and correlate it with body image, HbA1C and depression. Methods: Sixty adolescents with T1D (30 on CSII and 30 on basal-bolus regimen), aged 12–17 years were studied focusing on diabetes-duration, insulin therapy, exercise, socioeconomic standard, hypoglycemic attacks/week and family history of psychiatric illness. Anthropometric measures, HbA1C, binge eating scale (BES), body image tool, patient health questionnaire-9 (PHQ9) and the Mini-KID depression scale were assessed. Results: Among the studied adolescents with T1D, six had DEB (10%), 14 had poor body-image perception (23.3%), 42 had moderate body-image perception (70%) and 22 had depression (36.7%). Adolescents with T1D on CSII had significantly lower BES (p = 0.022), Mini-KID depression (p = 0.001) and PHQ9 (p = 0.02) than those on basal-bolus regimen. BES was positively correlated to depression (p < 0.001), HbA1C (p = 0.013) and diabetes-duration (p = 0.009) and negatively correlated to body-image (p = 0.003). Conclusion: DEB is a prevalent comorbidity among adolescents with T1D, with higher frequency in those on basal-bolus regimen than CSII. Plain English summary: Disordered eating behaviour is a significant morbidity among people with type 1 diabetes. It is associated with poor metabolic control and diabetes related complications even when the full diagnostic criteria of an eating disorder are not met. There is conflicting data in the literature regarding the prevalence of disordered eating behaviour in type 1 diabetes. The current study found that disordered eating behaviour is prevalent among 10% of the studied adolescents with type 1 diabetes. It was found to be more severe and frequent among those on basal-bolus insulin regimen than those on continuous subcutaneous insulin infusion. Moreover, it was correlated with depression, poor glycemic control, poor body image and long diabetes duration. Thus further studies are needed to verify the role of continuous glucose monitoring in the management of DEB among those with T1D. [ABSTRACT FROM AUTHOR]

Background: Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented. Methods: This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%. Results: Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set. Conclusions: Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China. Plain English summary: Previous studies have identified multiple risk factors of eating disorders that are related to emotion regulation and coping strategies in the Western context. However, most of these studies failed to describe any kind of hierarchy or interaction between risk factors that co-occur. To address this knowledge gap, the present study investigated a broad range of risk factors from the perspective of emotion regulation and then used a decision tree classification method to screen for EDs among young women in China. Results showed that body image inflexibility, psychological distress, and body dissatisfaction were the primary classifiers for Chinese women at high risk of EDs. [ABSTRACT FROM AUTHOR]

Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders, but the adjunctive benefit of synchronous peer support has yet to be investigated. In the current study, a randomised controlled trial was conducted to evaluate the effectiveness of an indicated Internet-based prevention program (ProYouth OZ) with and without peer-to-peer support in reducing disordered eating behaviours and attitudes. Method: Fifty young adults (18–25 years) with eating disorder symptoms were randomised to one of three study conditions: (1) ProYouth OZ (without peer-to-peer support), (2) ProYouth OZ Peers (with peer-to-peer support), and (3) a waitlist control group. Outcomes were assessed at three different time points. Eating disorder symptoms (primary outcome) were measured with the Eating Disorder Examination Questionnaire. Results: Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms. Fifteen participants (30%) completed the post-intervention survey. Of the two intervention groups, 20.6% failed to access any component of the program. Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions. Due to limited outcome data, it was not possible to statistically examine between-group differences in outcomes. Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ. Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community. The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs. offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology but may not be ready or able to seek professional face-to-face treatment. Trial registration: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527 Plain English summary: Internet-based prevention programs for eating disorders are effective, but a variety of challenges have been found when offering them in real-world settings. The current study aimed to test ProYouth OZ, an Internet-based eating disorder prevention program consisting of multiple components including peer support. In total, 50 young adults (18–25 years) with eating disorder symptoms were allocated to one of three versions of the program. In total, 21% did not access the program. From 17 participants in the peer support group, 60% attended at least one chat session and 12% attended all six sessions. Given that only fifteen participants (30%) completed the questionnaire after the intervention, it is not possible to draw reliable conclusions about the effectiveness of the program. Findings demonstrate the difficulty of recruiting emerging adults, engaging them with the program and collecting data after participation. The majority of interested participants experienced an eating disorder, suggesting they may be searching for help online. Future studies should investigate the use of peer support, identify strategies for reaching eligible participants and develop approaches to increase engagement. Finally, it is important to develop innovative programs that provide self-help strategies and facilitate help-seeking for those who are experiencing an eating disorder. [ABSTRACT FROM AUTHOR]

Background: Body image disturbance is central to both the understanding and treatment of anorexia nervosa (AN); however, the underlying psychological processes involved are still not well understood. One way towards a better understanding of these mechanisms may be to explore the sense of embodiment in these patients in an attempt at integrating the role of the body in our understanding of the development of self in AN. It is hypothesized that difficulties in affective experiences of embodiment is related to insecure attachment, deficits in mentalization and self-objectification. Methods: Sixteen inpatients with AN were interviewed with the Mirror Interview (MI). In the interview, the individual is asked a set of questions related to thoughts and feelings about the body while standing in front of a full-length mirror. Furthermore, all patients were assessed with the Adult Attachment Interview, which was coded for both attachment and mentalization (operationalized by the Reflective Functioning scale; RF). Self-objectification was measured with the Objectified Body Consciousness Scale (OBCS). Results: Results from a multiple regression analysis showed that Global MI scores were significantly associated with Coherence of mind as an indicator of attachment, RF and scores on the OBCS. Conclusions: The study suggests that affective experiences of embodiment in patients with AN are associated with negative attachment representations, mentalizing impairments and objectified body consciousness. Plain English Summary: Body image disturbance is a key diagnostic feature in anorexia nervosa but the underlying psychological processes are poorly understood. Recently, there has been a growing interest in how disturbances in the more psychological experience of the body (embodiment) in anorexia nervosa is related to both attachment, how individuals make sense of both themselves and others and the degree to which they tend to experience ourselves from the outside. In this pilot study, this was assessed with an innovative interview, the Mirror Interview, where the individual is asked a set of question while standing in front of a full length mirror. Results showed that difficulties in embodied experiences in patients with anorexia nervosa were related to more fundamental representations of self and self-objectification. This has potential implications for both the understanding and treatment of anorexia nervosa, as disturbances in body image may be seen as an underlying factor in the development of an eating disorder. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has seen worsened mental health as a result of lockdowns, isolation and changes to sociocultural functioning. The postponement of the Tokyo 2020 Olympics is representative of global cancellations of sporting events, reduced facility access and support restrictions that have affected both current and former athlete's psychological wellbeing. This study aimed to determine whether current (n = 93) and former (n = 111) athletes experienced worsened body image, relationship with food or eating disorder symptomatology during acute COVID-19 transitions. Methods: The study was a Convergent Mixed Methods design whereby qualitative content analysis was collected and analysed simultaneously with quantitative cross-sectional data using the EAT-26 and self-report COVID-19 questions. Data were collected from April until May 2020 to capture data pertaining to transitions related to the pandemic and included individuals across 41 different individual and team sports from club to international competition levels. Results: There was a surge in disordered eating in current and former athletes as a result of the early COVID-19 response. Eating disorders were suggested to occur in 21.1% of participants (18% current athletes n = 17, 25% former athletes (n = 26). There was a significant difference between males and females (p = 0.018, r = 0.17), but interestingly no differences between groups from individual vs team sports, type of sporting category (endurance, antigravitational, ball sport, power, technical and aesthetic) or level of competition (club, state, national or international). 34.8% (n = 69) self-reported worsened body image and 32.8% (n = 65) self-reported a worsened food relationship directly from COVID-19. Qualitative analysis indicated that disordered eating occurred predominantly in the form of body preoccupation, inhibitory food control, fear of body composition changes and binge eating. Conclusions: This study indicates that transitions in COVID-19 have worsened food-body relationships in current and former athletes and must be treated as an at-risk time for eating disorder development. We suggest that resources are allocated appropriately to assist athletes to foster psychologically positive food and body relationships through COVID-19 transitions. This study makes practice suggestions in supporting athletes to manage control, seek support, adapt and accept change and promote connection and variety through athletic transitions. Plain English summary: The current study looked to explore how current and former athletes' disordered eating had been affected in response to the COVID-19 pandemic. We found that disordered eating had worsened in both population groups and was described through increases to food preoccupation, control, binge eating, dietary restriction and fear of body composition change. This study offers suggestions on how to best support current and former athletes through COVID-19 transitions, further relating these findings to athletic transitions such as retirement, injury, pregnancy and illness. [ABSTRACT FROM AUTHOR]

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Background: Despite evidence that thinness and muscularity are part of the female body ideal, there is not yet a reliable figure rating scale measuring the body image of women which includes both of these dimensions. To overcome this shortcoming, the Body Image Matrix of Thinness and Muscularity - Female Bodies (BIMTM-FB) was developed. Methods: The objective of this study is to analyze the psychometric properties of this measure. N = 607 non-clinical women and N = 32 women with eating disorders answered the BIMTM-FB as well as instruments assessing eating disorder symptoms and body image disturbance in order to test the convergent validity of the BIMTM-FB. To assess test-retest reliability, a two-week interval was determined. Results: The results indicated that the body-fat dimension of the BIMTM-FB correlates significantly with the Contour Drawing Rating-Scale, the Drive for Leanness Scale (DLS) and the Body Appreciation Scale, while the muscularity dimension of the BIMTM-FB was significantly associated with the DLS and the Drive for Muscularity Scale, proving the convergent validity of the BIMTM-FB. High coefficients of test-retest reliability were found. Moreover, the BIMTM-FB differentiated between the clinical sample and the non-clinical controls. Conclusions: The BIMTM-FB is a figure rating scale assessing both thinness and muscularity as part of the female body ideal. Due to its high reliability and validity, the BIMTM-FB can be recommended in research and practice. [ABSTRACT FROM AUTHOR]

Background: Body image disturbance and alexithymia are two core aspects of Eating Disorders (EDs). However, standard treatments for EDs do not include specific techniques to approach these issues on a bodily level. This pilot study evaluated the effects of a Dance Movement Therapy (DMT) intervention on body image and alexithymia in patients with EDs, and also explored their experience of the therapeutic process. Method: 14 patients with EDs were recruited from a private clinic. Seven were assigned via quasi-randomization to the DMT group and the others (n = 5) continued their treatment as usual. The length of the intervention was 14 weeks. All participants completed the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Toronto Alexithymia Scale (TAS-20) at the beginning and at the end of the intervention. Additionally, the DMT group wrote reflective diaries about their experience at the end of each session, which were analyzed using qualitative methods. Results: Between the pre- and post-intervention, the participants of the DMT group significantly improved in Body Areas Satisfaction (effect size: 0.95) and Appearance Evaluation (effect size: 1.10), and they decreased significantly in Appearance Orientation (effect size: 1.30). A decrease in Overweight Preoccupation was observed (effect size: 0.75), however this was not statistically significant. The control group did not show significant changes in any of the MBSRQ subscales. Neither the DMT group nor the control group improved significantly in the alexithymia scores. The qualitative analysis revealed valuable insights into the participants' processes throughout the sessions. In general, participants received the DMT intervention positively. They reported improvements in their mood states and an increase in their self-awareness. They also appreciated the relationship with the group and the therapist. Conclusion: These results indicate that DMT might be a complementary treatment option for EDs, as it may be able to address body image issues more effectively than verbal therapies. More studies with larger samples are needed to confirm these promising preliminary results. [ABSTRACT FROM AUTHOR]