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Background: Adolescents, particularly vulnerable during puberty, often face heightened concerns about dieting and body image. Transfeminine youth, especially in Asian cultures, are understudied in this context. This study investigates eating disorder risks among Thai transfeminine youth and compares to cisgender females, focusing on the association with body dissatisfaction. This study aims to explore 3 objectives: (1) to assess and compare the prevalence of eating disorder risks between Thai transfeminine youth and cisgender females; (2) to examine the link between body dissatisfaction and eating disorder risks; (3) to identify risk factors associated with abnormal eating disorder screening outcomes. Method: This is a cross-sectional comparative study conducted between September 2021 and October 2022. The study questionnaire includes Thai version of the Eating Attitude Test-26 (EAT-26) to assess the risks of eating disorders and Thai version of the Body Image Concern Inventory (BICI) to assess body dissatisfaction. The questionnaire was distributed through social media platforms to transfeminine and cisgender females, aged 12–25 years. The correlation between eating disorder risks and body dissatisfaction was analyzed with linear regression, while the comparisons between transfeminine individuals and cisgender female groups were analyzed with Wilcoxon rank-sum test. Results: The study included 241 transfeminine individuals and 388 cisgender females, median age 19.0 years (interquartile range [IQR] 18–21) and 18 years (IQR 16–20), respectively. Ninety (37.3%) transfeminine individuals had an EAT-26 score ≥ 20, suggesting concerns for dieting and eating behaviors, compared to 70 (18%) cisgender females (p < 0.001). Risk factors for EDs included obesity (odds ratio [OR] 3.22, confidence interval [CI] 1.36–7.6) and low income (OR 3.66, CI 1.59–8.4). Protective factors were negligible exercise (OR 0.24, CI 0.09–0.66), gender identity disclosure (OR 0.27, CI 0.1–0.77), and high levels of happiness (OR 0.85, CI 0.73–0.98). There is a significant correlation between the positive eating behavior screening and the body dissatisfaction scores. Conclusions: Transfeminine youths show significantly higher concerns about dieting, body weight, and eating behaviors than their cisgender females, highlighting the unique challenges they face. These results emphasize the needs for targeted screening, health care access for treatment and support for eating disorders in transfeminine youths. Plain English summary: Teenagers often worry intensely about their body image, a concern that can escalate to eating disorders. Transfeminine teenagers—those assigned male at birth who identify and express themselves as female—may encounter even greater challenges, yet research on this topic, especially in Asian contexts, remains sparse. This study investigated the eating habits of transfeminine teenagers in Thailand and compared them with those of their cisgender female counterparts. Conducted online with participants aged 12 to 25 from September 2021 to October 2022, the results indicate that transfeminine youths are more susceptible to behaviors that heighten the risk of eating disorders. Contributing factors include obesity and low income, which exacerbate these risks, while openly disclosing their gender identity and experiencing high levels of happiness appear to offer some protective effects. These findings underscore the urgent need for enhanced support and greater awareness for transfeminine adolescents at risk. [ABSTRACT FROM AUTHOR]

Background: This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included. Case study: The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective. Methods: In this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder. Outcomes: The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs. Conclusion: This case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant. Recommendations: We advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted. Plain language summary: This case study, with commentaries from two other patients who have recovered from severe and longstanding anorexia nervosa, examines the use of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe and longstanding anorexia nervosa and multiple comorbidities. The patient had a history of multiple hospitalisations and was treated with various psychotropic medications without success for 17 years. However, she responded to I-CBTE. The model integrates multidisciplinary treatment to address the eating disorder and co-occurring conditions effectively. The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the effectiveness of the I-CBTE approach in patients with complex, longstanding and severe eating disorders. This intervention is cost-effective and has significant financial advantages for healthcare systems. The authors recommend further research into the long-term effectiveness of I-CBTE and broader integration of CBT for ED into clinical services and existing treatment frameworks to enhance care for patients with severe and longstanding eating disorders. Systematic training and supervision for multidisciplinary teams is needed and patient feedback on experiences of integrated models of care such as I-CBTE is also needed. Finally, systematic health economics studies should be conducted. [ABSTRACT FROM AUTHOR]

Background: The level of experienced sociocultural pressure to have an idealized body can vary depending on a person's gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health. Methods: An online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated. Results: Non-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure. Conclusions: Data in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation. [ABSTRACT FROM AUTHOR]

Body dissatisfaction during pregnancy can significantly impact maternal and child health. Therefore, this longitudinal study investigated changes in body dissatisfaction using two figure rating scales developed from photographic digital data of Japanese pregnant women during the sixth and tenth months of pregnancy. Study participants were recruited at their sixth month prenatal visit at a primary maternity clinic in Japan from October 2014 to March 2015. Body dissatisfaction was estimated based on the perceived and ideal body sizes of 135 pregnant women, expressed as body mass index. Data were collected using selfadministered questionnaires. The study found that body dissatisfaction in the tenth month was significantly higher than that in the sixth month. Among the participants, 75 (55.6%) and 79 (58.5%) experienced body dissatisfaction, desiring to be thinner (where perceived body size exceeded ideal body size) during the sixth and tenth months of pregnancy, respectively. Pregnant women who had body dissatisfaction and a desire to be thinner in the sixth month tended to experience an increase in body dissatisfaction by the tenth month compared to those without body dissatisfaction in the sixth month. During the sixth and tenth months, women with body dissatisfaction showed significantly larger perceived body sizes than those without body dissatisfaction. These results indicated that the use of a figure rating scale at the sixth month of pregnancy may help identify women with body dissatisfaction; moreover, perceived body size might be a key factor in preventing an increase in body dissatisfaction from the second to third trimesters. [ABSTRACT FROM AUTHOR]

Purpose: Sexual and gender minorities (SGMs) show a heightened risk of disordered eating compared to heterosexual and cisgender people, a disparity which may be caused by exposure to minority-specific stressors, such as discrimination and violence. This systematic review aims to summarize available evidence on the role of minority stress in disordered eating and SGM-specific aspects. Methods: Following PRISMA guidelines, scientific search engines (EBSCO, PUBMED, Web of Science) were screened up to 31st of January 2024, including English-language original research papers containing analyses of the relationship between minority stress and disordered eating. 2416 records were gathered for screening. After application of inclusion and exclusion criteria, thematic analysis was conducted regarding 4 research questions: effects of minority stress on disordered eating, mediating factors, specificities of SGMs and differences between identity categories. Results: 30 studies were included. Several aspects of minority stress are reliably associated with different forms of disordered eating. The relationship between minority stressors and disordered eating is mediated by aspects such as shame, body shame, or negative affect. SGMs show several specificities, such as the presence of a role of LGBTQIA + communities and additional gender-related pressures. Bisexual people and gender minorities appear to feature comparatively higher risks, and gender-related factors shape paths leading to disordered eating risk. Conclusion: Minority stress is an important predictor of disordered eating, making SGM people's health particularly at risk. Institutional and organizational anti-discrimination policies are needed, as well as further research. Clinical interventions may benefit from exploring and incorporating how minority stressors impact SGM people. Evidence level I—Systematic review. [ABSTRACT FROM AUTHOR]

Purpose: Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy’s physiological changes in body shape through reduced calorie intake or increased physical activity. Methods: In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake. Results: Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy. Discussion: The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies. Level of Evidence: Level I—Evidence obtained from: systematic reviews and meta-analyses. [ABSTRACT FROM AUTHOR]

Background: As women continue to be more at risk from eating disorders, gender has often been a focus of concern in transcultural research. Yet feminist, qualitative studies which prioritize the voices of women/girls remain rare within transcultural work suggesting the need for greater interaction between these fields. This article seeks to contribute to the exploration of the applicability of feminist paradigmslargely developed in the West—to experiences of EDs in non-western contexts. Methods: This article draws on semi-structured interviews with 12 women from urban China with self-reported experience of Bulimia Nervosa (BN) and binge eating disorder (BED) in order to explore the complex ways in which gender may be implicated within eating/body distress from a transcultural point of view. The data is analysed through Reflexive Thematic Analysis. Results: The data analysis suggested two broad themes: (1) Chinese versus Western codes for judging female appearance: from surveillance to liberation (2) Discipline, appetite and control: the gendered/cultural meanings of binging and purging. In terms of the first theme, many participants had spent time in the West which was understood as a less regulated context in terms of gendered body surveillance and eating. Complicating existing assumptions about the ‘Westernisation’ thesis, different communication codes and peer interactions across Chinese and Western contexts played a central role in how participants experienced their bodies. In the second theme, binging and purging emerged as a way to manage a number of contradictions surrounding Chinese femininity, including respecting familial food cultures, contradictory discourses on female ‘appetite’, and the need to display a female body which signified cultural imperatives of self-restraint and discipline. Conclusions: The data emphasises the importance of examining the culturally specific meanings of eating problems and their gendered contexts, whilst there is clearly much that echoes Western feminist work on Western samples. Although limited, the study crucially points to the importance of examining how ED subcategories other than AN can be explored from a transcultural and feminist point of view.Plain English summary: This articles adopts a feminist approach to explore experiences of eating disorders (EDs) in China. Drawing upon interviews with 12 women from urban China with experience of self-reported Bulimia Nervosa (BN) and Binge Eating Disorder (BED), it examines the relationships between eating problems and gender—from social norms regarding body and appearance to women’s social roles. The vast majority of feminist work on EDs has been developed in the West. The article explores how applicable this research is to these women’s experiences in China, whilst examining how the Chinese context highlights culturally specific aspects of EDs. [ABSTRACT FROM AUTHOR]

Background: The post-partum period is a vulnerable time for mothers in terms of eating disorder symptoms and is critical for the establishment of feeding patterns in infants. This study aimed to investigate the relationships between maternal eating disorder symptoms and objective indices of feeding regulation at 3 months, as well as perceived breastfeeding self-efficacy.Methods: A sample of n = 73 full-term mother-child dyads (44% female) participated in the study. Mothers self-reported eating disorder symptoms and breastfeeding self-efficacy and objective indices of infant feeding regulation were obtained in the home.Results: Findings revealed the existence of relationships between higher maternal eating disorder symptoms, and objective indices of infant feeding regulation with substantial gender differences in the patterns emerging. Among mother-daughter dyads, maternal weight and shape concerns were associated with higher infant transfer volume and rate during bottle feeding. In contrast, among mother-son dyads, higher maternal eating disorder symptoms, including weight, shape, and eating concern, were associated with lower infant transfer volume and rate as well as lower levels of proficiency while taking their bottle.Conclusion: Relationships emerged between higher maternal eating disorder symptoms and feeding regulation with substantial gender differences in these patterns. Additional research clarifying the underlying mechanisms of these associations is warranted and further efforts should be directed towards supporting mothers during the postpartum period. [ABSTRACT FROM AUTHOR]

Background: Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms. There is a paucity of literature on how body image affects the breastfeeding practices of nurses and midwives. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affected their breastfeeding practices. Methods: A qualitative design was used in this study. Five focus group discussions were conducted with each group having five members. The study was conducted in the Greater Accra Region of Ghana between November and December of 2020. Participants were recruited into the study using a purposive sampling method. Focus group sessions were audiotaped and transcribed verbatim. Data were analyzed using a content analysis. Results: Three main themes emerged from the data analysis: body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants had concerns regarding weight gain due to the need to eat adequately while breastfeeding. Body image concerns included increase in abdominal size, sagging breasts and generalized weight gain. These concerns and pressures negatively affected the breastfeeding practices of participants. Body image concerns reflected sociocultural pressures such as negative comments from loved ones and in the social media. The coping strategies adopted by the mothers were self-motivation and the love they had for their children. Conclusions: The perspectives of breastfeeding nurses and midwives on the ways their body image affected their breastfeeding practices identified the need for support in order to successfully breastfeed. [ABSTRACT FROM AUTHOR]

Background: There are fundamental and rapid changes in body shape during pregnancy, some of which persist for an extended time after delivery and may cause dissatisfaction with body shape. Therefore, we conducted this study to determine predictors of body dissatisfaction at six months postpartum based on demographic and fertility factors.Methods: This cross-sectional study was conducted on 300 women who referred to seven health centers affiliated with Iran University of Medical Sciences, Tehran, Iran. The sampling was multistage and we collected data from a demographic and fertility questionnaire and Cooper's Body Shape Questionnaire (BSQ-34). The independent t-test, Mann-Whitney U test, chi-square test, one-way ANOVA, Kruskal-Wallis, Pearson correlation coefficient, and multiple linear regression were used for data analysis. The level of significance was set at P < 0.05.Results: The mean age of participating women was 29.77 (standard deviation: 5.9) years. Body dissatisfaction had a statistically significant association with variables such as body mass index (BMI) at six months postpartum, gestational age, the receipt of information about body shape, spouse's views on the shape of a woman's body, and mode of delivery. These variables predicted 34% of body dissatisfaction based on multiple linear regression.Conclusion: Postpartum body dissatisfaction is related to a several variables. Paying attention to these variables will help to plan and improve postpartum counseling and educational programs. [ABSTRACT FROM AUTHOR]