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The article discusses the criteria for the development of health promotion and education programs in the U.S. Several organizations and agencies express their interest in sponsoring health promotion or disease prevention programs for their members, clients, employees, or beneficiaries. This paper addresses five criteria that suggest several issues and questions during decision-making process. The first criterion involves the program's respond to one or more risk factors, that are defined, measurable and prevalent among the members of the selected target group. The second criterion is the consideration of the special characteristics, needs and preferences of the target group.

Focuses on the implication of literature on black theological ethics. Interpretation in the dichotomy of body and soul; Definition of Christian anthropology; Indication of faith-system and moral values.

This theoretical review paper offers a sociocultural-developmental framework for understanding LGBTQ+ adolescents' body image concerns and disordered eating risk. The Pride Framework integrates well-established sociocultural theories and extant empirical research, drawing from objectification theory, the tripartite influence model, minority stress theory, and intersectionality theory. The Pride Framework situates sociocultural appearance pressures within the adolescent developmental context, wherein biological, cognitive, and social transitions exacerbate the likelihood of body image disturbances and eating pathology. Various processes are then posited to link these sociocultural-developmental pressures to body image concerns and disordered eating. Crucially, this framework underscores that LGBTQ+ status itself does not pose a risk for body dissatisfaction and eating disorders. Instead, it is the experience of residing in a society that stigmatizes LGBTQ+ identities that increases youth's vulnerabilities. LGBTQ+ health researchers and practitioners are encouraged to engage in collaborative efforts with the aim of fostering acceptance for LGBTQ+ youth. This, in turn, could support normative adolescent identity exploration processes within sociocultural settings that are both affirming and inclusive, potentially mitigating adverse health consequences associated with body image disturbances.

Online appearance preoccupation may put adolescents at risk of developing mental health challenges, perhaps especially during early-to-middle adolescence. A random intercept cross-lagged panel model assessed within-person associations between appearance-related social media consciousness and depressive symptoms over three time-points with three months between waves. The sample (n = 1594) included U.S. adolescents aged 11-15 (Mage = 13; 47% girls, 46% boys, 7% another gender; 37% Latine, 33% White, 18% Black, 7% Asian). Within-person increases in appearance-related social media consciousness were associated with subsequent increases in depressive symptoms, but not vice versa. There was no evidence of gender differences and results were robust to controlling for both time on social media and offline self-objectification. Thus, online appearance concerns precede mental health challenges during early and middle adolescence., (© 2024. The Author(s).)

Hookup culture has transformed the sexual behavior of emerging adults. Feminism, a movement that has advocated for liberating women from sexual repression, may be associated with hookup endorsement attitudes. This study explores the associations among multiple dimensions of feminism, gender, and hookup culture endorsement. Participants included 318 emerging adults (46% women; Mage = 22.2 years; 51% White, 27% Asian, 5% Hispanic/Latinx, 9% Black, 1% Middle Eastern, 1% American Indian, 6% Multiracial) from five Anglophone countries (62% U.S., 23% United Kingdom, 9% Canada, 5% Australia, 1% New Zealand), who completed the Feminist Beliefs and Behavior Scale and Endorsement of Hookup Culture Index via an anonymous, online survey. Participants were categorized according to their feminist identity label (feminist, non-feminist) and feminist belief system (hold feminist beliefs, hold non-feminist beliefs). A series of ANCOVAs was conducted, revealing that women who identified as feminist and/or held feminist beliefs reported significantly higher endorsement of hookup culture compared to non-feminist women with non-feminist beliefs. Neither dimension of feminism predicted hookup culture endorsement in men. When comparing feminist-identifying women and men, the gender disparity in hookup culture endorsement was eliminated. Together, these findings highlight how social movements, such as feminism, may be associated with young women's attitudes towards hookups, and may ultimately shape their sexual experiences., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Improved oocyte competence for embryo development and pregnancy was observed following ovulation of preovulatory follicles with greater physiological maturity, as indicated by estradiol production, prior to the gonadotropin-releasing hormone (GnRH)-induced luteinizing hormone (LH) surge. It was hypothesized that follicular fluid from preovulatory follicles of greater maturity better supports the maturing oocyte's metabolic requirements and improves embryo development. The objective was to determine if differences in preovulatory follicular fluid due to follicle maturity influence oocyte metabolism during in vitro maturation (IVM) and affect embryo development. Bovine preovulatory follicular fluid was collected 18 h after a GnRH-induced LH surge. Serum estradiol concentration at GnRH administration categorized follicles as greater or lesser maturity. Immature bovine oocytes were submitted to 24 h IVM in medium supplemented with 20% follicular fluid from preovulatory follicles of greater or lesser maturity. Embryo development was recorded. Oocyte maturation media and media conditioned by developing embryos were submitted for metabolomics. A randomized block design was utilized to determine differences in embryo development and media metabolites ( P ≤ 0.05). Blastocysts from oocytes matured in greater vs. lesser maturity follicular fluid had a more moderate rate of development ( P = 0.01). At the conclusion of 24 h IVM, abundance of 66 metabolites differed between greater and lesser follicle maturity treatments. Nine metabolites differed in media conditioned by developing embryos. Metabolome results suggest improved amino acid, purine, and glucose metabolism, followed by a more efficient rate of embryo development, in oocytes matured in greater vs lesser maturity follicular fluid., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Competing Interests: Declaration of competing interest Savannah R. Roberts and Tiffany A. Brown served as guest editors for this special issue of Eating Behaviors. Additionally, this material is based upon work supported by the National Science Foundation Graduate Research Fellowship awarded to Savannah R. Roberts. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

Multidrug efflux is one of the major mechanisms of antibiotic resistance identified in clinical isolates of the human pathogen Acinetobacter baumannii . The multiple antibiotic resistance in this species is often enabled by the overproduction of the tripartite efflux pump AdeABC. In this pump, AdeB is the inner membrane transporter from the resistance-nodulation-division (RND) superfamily of proteins, which is responsible for the recognition and efflux of multiple structurally unrelated compounds. Like other RND transporters, AdeB is a trimeric protein with ligand-binding sites located in the large periplasmic domains. Previous structural studies, however, highlighted the uniqueness of AdeB interactions with ligands. Up to three ligand molecules were bound to one protomer of AdeB, mapping its substrate translocation path. In this study, we introduced single and double substitutions in the identified ligand-binding sites of AdeB. Our results show that the mechanism of substrate translocation by AdeB is different from that of other characterized RND transporters and that the functional interactions between the sites are nonadditive. We identified AdeB mutants with both the loss and the gain of antibiotic susceptibility phenotypes, as well as AdeB mutations making A. baumannii cells overproducing such pump variants even more susceptible to multiple antibiotics than efflux-deficient cells. IMPORTANCE Multidrug efflux pumps of the resistance-nodulation-division superfamily of proteins are important contributors to various aspects of bacterial physiology and antibiotic resistance. Studies of the best-characterized model transporter AcrB from Escherichia coli suggested that these transporters operate by a functional rotation mechanism in which various substrates bind to at least two different binding sites. This study suggests that the mechanism of AdeB is distinct and that the binding sites in this transporter are functionally linked., Competing Interests: The authors declare no conflict of interest.

Introduction: Preovulatory follicle response to the luteinizing hormone (LH) surge leads to metabolic, molecular, and functional changes in the oocyte and somatic follicular cells from the onset of estrus to ovulation. Follicular fluid contains metabolites, miRNAs, proteins, and hormones that are byproducts of follicular metabolism and support cellular processes of oocyte, cumulus, and granulosa constituents. Numerous studies have highlighted the importance of follicular fluid composition to support fertility, but critical gaps exist toward understanding dynamic modifications in the follicular fluid metabolome from estrous onset to ovulation. The hypothesis was that abundance of follicular fluid metabolites is dependent on follicle progression post LH surge and variability in follicular fluid metabolome profiles indicate key processes required for preparation of the follicle and oocyte for optimal fertility. The objective was to generate preovulatory follicular fluid metabolome profiles and discern differences in the metabolome of preovulatory follicular fluid samples collected at onset of estrus, 11 h post estrous onset, and 18 h post estrous onset. Methods: Estrus was synchronized in non-lactating Jersey cows (n=40) and follicular fluid was collected immediately after the first observed standing mount (hr 0) or at approximately h 11 or 18 after the first standing mount. Ultra-High-Performance Liquid Chromatography-High Resolution Mass Spectrometry was performed on preovulatory follicular fluid samples ( n = 9 collected at hr 0, 9 at h 11, and 10 at h 18) and a multiple linear model was performed to determine if time post estrous onset impacted metabolite abundance. Results: Metabolites influenced by time post estrous onset were tested for enrichment in KEGG pathways. Ninety metabolites were identified in follicular fluid samples. Twenty metabolites differed in abundance among timepoints post estrous onset ( p ≤ 0.05). Pathways corresponding to amino acid and energy metabolism were enriched with metabolites impacted by time post estrous onset (FDR ≤ 0.10). Discussion: Results from the current study indicate early response to the LH surge to increase bioavailability of amino acids and metabolites used by the cumulus and granulosa cells for energy production and shuttled into the oocyte to support meiotic maturation. Such metabolites may later be used by the ovulatory follicle for protein production., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hessock, Edwards, Schrick, Payton, Campagna, Pollock, Clark, Stokes, Klabnik, Hill, Roberts, Hinson and Moorey.)

Objective: To examine distinct types of social comparisons (i.e. self-evaluations relative to others) in behavioural weight loss groups and their relations with weight loss maintenance., Design: Participants ( N  = 127, M BMI = 35.66 kg/m 2 ) reported on their comparisons at mid-treatment (6 months), including identification of their primary individual comparison target (group member) and perceptions of their own treatment adherence versus that of their group and identified target., Main Outcome Measures: Weight was assessed at baseline, mid-treatment, end-of-treatment (12 months), and 18- and 24-month follow-ups., Results: Comparisons with individual targets perceived as more successful with weight loss were most frequent (i.e. upward comparisons), though comparisons differed based on group versus individual targets and specific treatment behaviours (e.g. self-monitoring). Comparisons did not align with participants' own treatment progress, suggesting that comparisons reflect more than just their objective weight loss relative to others. Relations between participants' initial weight loss and maintenance was moderated by the type of individual target identified at mid-treatment ( p  = 0.02, sr  = 0.27)., Conclusions: Social comparisons in group-based weight loss treatment are multifaceted and predict long-term weight loss maintenance. Additional work is needed to determine how best to harness comparison processes to promote success in behavioural weight loss treatment.

Background: The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs)., Methods: A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time., Results: A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications., Conclusions: The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology., Methods: Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, M age  = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey., Results: Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant., Conclusions: Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association., Public Significance: The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology., (© 2022 Wiley Periodicals LLC.)

In this theoretical review paper, we provide a developmental-sociocultural framework for the role of social media (SM) in adolescent girls' body image concerns, and in turn, depressive symptoms and disordered eating. We propose that the features of SM (e.g., idealized images of peers, quantifiable feedback) intersect with adolescent developmental factors (e.g., salience of peer relationships) and sociocultural gender socialization processes (e.g., societal over-emphasis on girls' and women's physical appearance) to create the "perfect storm" for exacerbating girls' body image concerns. We argue that, ultimately, body image concerns may be a key mechanism underlying associations between adolescent girls' SM use and mental health. In the context of proposing this framework, we provide empirical evidence for how SM may increase adolescent girls' body image concerns through heightening their focus on (1) other people's physical appearance (e.g., through exposure to idealized images of peers, celebrities, and SM influencers; quantifiable indicators of approval); and (2) their own appearance (e.g., through appearance-related SM consciousness; exposure to idealized self-images; encouraging over-valuing of appearance; and peer approval of photos/videos). Our framework highlights new avenues for future research on adolescent girls' SM use and mental health, which recognize the central role of body image., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

There is a dearth of research examining Black adolescents' body image, with even less work examining gender differences or the influence of ethnic-racial identity (ERI) commitment. It is critical to understand how culturally relevant aspects of appearance-beyond commonly measured ideals such as thinness and muscularity-are particularly relevant to Black adolescents. The present study of Black youth (n = 252; 55% girls, 45% boys, ages 13-18, M age = 15.5) explored the roles of gender and ERI commitment in the associations between skin tone, hair, and facial satisfaction and appearance esteem, depressive symptomatology, and self-objectification. With a few exceptions, satisfaction with skin tone, hair, and face were significantly associated with higher appearance esteem and lower self-objectification and depressive symptoms, even when controlling for weight and muscle tone satisfaction. Findings were similar across genders, with some associations stronger among Black girls relative to boys. Among youth with higher ERI commitment, associations were stronger between skin tone, hair, and facial satisfaction and some indicators of wellbeing. Findings elucidate the role of culturally relevant appearance concerns of Black adolescents and the potential benefits of ERI commitment. This work can inform culturally sensitive research practices and therapeutic interventions related to Black youth's body image experiences., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Appearance-related social media consciousness (ASMC) is the persistent awareness of one's attractiveness on social media. The ASMC Scale, recently developed for use with adolescents (Choukas-Bradley et al., 2020), provides a promising tool for systematically examining ASMC and associations with mental health. The current study examined the psychometric properties of the ASMC Scale among emerging adult men and women. Participants for Study 1 were 428 emerging adults (M age = 21.9) from five Anglophone, industrialized countries (U.S., U.K., Canada, Australia, New Zealand). Results from Study 1 provide evidence that the 13-item ASMC Scale has a unidimensional structure, strong internal consistency, measurement invariance across gender, and convergent validity (i.e., associations with related offline appearance concerns and cognitions) and incremental validity (i.e., associations with depressive symptoms and disordered eating, above and beyond time spent on social media). Participants from Study 2 were 296 U.S. college students (M age = 18.6). Results from Study 2 confirmed the factor structure and further demonstrated the convergent and incremental validity (above and beyond both time spent on social media and offline appearance concerns) of the ASMC Scale. Findings suggest that the ASMC Scale can be used among emerging adults, aiding future research investigating social media experiences and mental health., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Sexual and gender minority (SGM) rural adolescents are at risk for higher levels of social isolation, a well-known risk factor for depression and other negative health outcomes. We qualitatively examined how rural SGM youth seek emotional and informational support, which are protective factors for social isolation on social media (SM) regarding their SGM identity, and determined which SM platforms and tools are most effective in providing support. We conducted semistructured online interviews with rural SGM teens who screened positive for social isolation in spring 2020 and used a thematic analysis approach to analyze the data. Sixteen youths participated in interviews. Themes included seeking emotional support through SM groups and communities, seeking emotional support in designated online SGM spaces, using SM feeds for informational support, and disclosing SGM identity differentially across platforms. SM-based interventions could be leveraged to provide emotional and informational support for rural SGM youth across specific SM platforms and consider whether they are providing emotional or information support. Interventions focused on informational support may best be used on content-based platforms. Those designed to combat social isolation and connect marginalized SGM youths to similar others might benefit from community and forum-based platforms.

Objective: Sexual and gender minority (SGM) adolescents disproportionately report disordered eating, yet have primarily been considered under a larger SGM umbrella. The current study 1) compared disordered eating between sexual minority (SM) and gender minority (GM) adolescents; 2) examined how general psychological factors (self-esteem, depression, and stress) and SGM-specific factors (e.g., feelings about SGM identity, access to SGM resources) were associated with disordered eating; and 3) examined whether associations between these factors differed for SM versus GM adolescents., Method: SGM adolescents in the U.S. (N = 8814; 35.0% GM; 43.7% cisgender girls; 66.9% White; M age  = 15.6) reported their disordered eating, depressive symptoms, stress, self-esteem, and SGM-related experiences on an anonymous, cross-sectional online survey., Results: GM adolescents exhibited a higher prevalence of clinical threshold disordered eating than SM adolescents. Self-esteem was associated with lower odds of caloric restriction, purging, and binge eating. Depression was associated with higher odds of caloric restriction, diet pill use, purging, laxatives, and binge eating. Stress was associated with higher odds of purging. Associations were stronger for GM adolescents' caloric restriction. Positive feelings about SGM identity were associated with lower odds of caloric restriction, purging, and binge eating, whereas greater stress of "coming out" was associated with higher odds of caloric restriction, purging, and binge eating., Discussion: These results suggest that SGM adolescents' disordered eating is associated with both general psychological factors and unique SGM experiences. Results highlight the importance of considering how the unique experiences of SGM youth may leave them vulnerable to disordered eating behaviors., Public Significance Statement: Sexual and gender minority (SGM) youth are disproportionately affected by disordered eating. The current study found that higher depression and stress, and lower self-esteem, were associated with SGM adolescents' disordered eating. Furthermore, unique SGM experiences, such as stress about coming out, were also associated with eating pathology. Results highlight the importance of considering SGM adolescents' perceptions of their identity and social support., (© 2022 Wiley Periodicals LLC.)

Purpose: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth living in rural areas who feel isolated are at high risk of depression and suicidality. Given the lack of support in their offline communities, many rural-living LGBTQ youth turn to social media for social support. In this qualitative study, we examined rural LGBTQ youth's social media experiences and attitudes toward technology-based interventions for reducing perceived isolation., Method: In Spring 2020, we conducted online interviews with LGBTQ youth aged 14-19, living in rural areas of the United States, who screened positive for perceived social isolation (n = 20; 11 cisgender sexual minority, 9 transgender). Interviews examined (1) supportive social media experiences, (2) personal strategies to improve social media experiences, and (3) perspective on potential digital intervention delivery modalities. Data were analyzed using thematic analysis., Findings: Related to supportive content and interactions, themes included (1) positive representation of and connecting with LGBTQ groups on social media are important; (2) content from people with shared experience feels supportive, and (3) lack of feedback to one's experiences is isolating. Regarding personal strategies to improve social media experiences, themes were (1) selecting platforms to connect with different audiences helps make for a more enjoyable social media experience, and (2) several social media platform features can help make for a safer social media experience. Youth discussed advantages and disadvantages of intervention delivery via a mobile app, social media pages or groups, conversational agents (chatbots), and a dedicated website., Conclusion: Viewing positive representation of and connecting with LGBTQ groups, content from people shared experiences, and utilizing a wide array of platform features to increase the likelihood of positive connections are key to a positive social media experience among this group. Combining delivery modalities is key to engaging rural-living LGBTQ youth in digitally delivered support interventions to reduce perceived isolation. Our results inform future intervention research and conversations about social determinants of health between providers and rural LGBTQ patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Escobar-Viera, Choukas-Bradley, Sidani, Maheux, Roberts and Rollman.)

The tripartite influence model stipulates that appearance pressures from three sources (family, peers, traditional media) lead adolescent girls to internalize a thin appearance ideal and engage in social appearance comparisons, resulting in body dissatisfaction (Thompson et al., 1999). Social media is a modern source of appearance pressure and, increasingly, adolescent girls desire an appearance that is both thin and muscular. The current study of U.S. adolescent girls (n = 543, M age = 15.58, 49.17% Latina, 28.18% White, 8.66% Black, 7.55% Asian, 6.45% multiracial/another race/ethnicity) incorporates social media appearance pressures and muscular ideal internalization into the tripartite influence model using structural equation modeling. Findings provided support for this adapted model: family, peers, traditional media, and social media contributed to body dissatisfaction. All appearance pressure sources were associated with appearance esteem via thin ideal internalization. Peer and social media pressures were both related to greater muscular ideal internalization, which was not significantly associated with appearance esteem. Social media was the only source of pressure associated with appearance esteem through both thin ideal internalization and body comparison. Findings highlight adolescent girls' pressure to look both thin and muscular, as well as the role of social media as a prominent source of appearance socialization., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Boys represent a small proportion of samples in randomized clinical trials (RCT) investigating evidence-based treatment for adolescents with anorexia nervosa (AN). Consequently, knowledge of potential gender differences in clinical characteristics and treatment response in adolescents is considerably limited., Methods: Secondary analyses of aggregated data from two RCTs were used to characterize baseline and end-of-treatment clinical features in male and female adolescents with AN (n = 228, 10.53% male). Mixed analyses of variance were used to investigate potential gender differences in treatment response relative to weight outcomes (% median BMI) and eating disorder cognitions (Eating Disorder Examination Global scores; EDE)., Results: There were no significant gender differences in prior inpatient care, illness duration, psychiatric comorbidity, or psychotropic medication use at baseline. Nor were there significant gender differences in binge eating, purging, or driven exercise at baseline or end-of-treatment. Girls reported elevated weight and shape concern compared to boys at baseline but overall reduction in EDE Global scores over the course of treatment did not differ according to gender. Boys gained more relative weight during treatment than girls, but this difference was statistically non-significant., Conclusion: Overall findings do not suggest significant differences in treatment outcome relative to weight or ED cognitions, by gender. Current evidence suggests that, with the exception of shape and weight concerns, boys present with cognitive and behavioral symptoms as severe as their female counterparts which underscores the need for increased accuracy in assessment of these disorders in boys and young men., Level of Evidence: Level 1, secondary data analysis of randomized controlled trials., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Frequent social media use among adolescents is associated with depressive symptoms, though prior work has overwhelmingly used cross-sectional designs and focused on "screen time." Subjective social media experiences, such as the concern with one's physical appearance on social media, may be more relevant to adolescents' depressive symptoms than mere frequency of use. Appearance-related social media consciousness (ASMC) is the preoccupation with one's physical attractiveness in social media photos and has been associated with depressive symptoms above and beyond frequency of social media use in prior cross-sectional work., Methods: In this brief report, we assessed this association longitudinally over 1 year within a diverse sample of highschool adolescents in the Southeastern US (n = 163, M age = 16.19; 55.8% girls; 44.8% White, 23.9% Black, 26.4% Hispanic/Latinx; 49.7% received free or reduced-price lunch)., Results: Baseline ASMC was associated with higher depressive symptoms 1 year later, even when controlling for time spent on social media. Although girls reported higher levels of ASMC, associations were similar for adolescent boys and girls. No evidence was found that heightened depressive symptoms at baseline were associated with higher ASMC 1 year later., Conclusions: The findings highlight the importance of physical appearance concerns on social media-above and beyond the frequency of use-in the development of depressive symptoms among adolescents. Implications for future research to examine the role of subjective social media experiences in adolescents' depressive symptoms are discussed., (© 2022 The Foundation for Professionals in Services for Adolescents.)

The stay-at-home orders of the COVID-19 pandemic disrupted U.S. adolescents' lives in numerous ways during the spring of 2020, including substantial changes to in-person routines and increased reliance on digital media. For adolescent girls, stay-at-home practices may have implications for body image concerns. In this research brief, we examine adolescent girls' pandemic-related body image concerns and longitudinal associations with depressive symptoms. The sample included 93 U.S. adolescent girls ( M age = 15.01; 68.8% White), with approximately 2/3 at temperamental risk for depression. Participants self-reported their depressive symptoms and pandemic-related body image concerns via online surveys at three assessments: Time 1 occurred in April/May 2020, approximately one month into stay-at-home orders, followed by two-week and seven-month follow-up assessments. Two pandemic-related body image concerns were assessed: (1) concerns about disrupted appearance-management routines and (2) evaluating one's appearance on video-chat. Both forms of pandemic-related body image concerns predicted depressive symptoms two weeks later, and concerns about disrupted routines also predicted depressive symptoms seven months later. In an era of social distancing, frequent technology-based interactions, and disrupted routines, future work should continue to investigate adolescents' body image concerns and the implications for longer-term mental health outcomes., Competing Interests: The authors have no conflicts to declare.

The present study examined whether body esteem mediates the associations between psychosocial factors, including peer victimization and parent-adolescent relationship quality, and multiple categories of disordered eating (DE) within a diverse sample of adolescent sexual minority (SM) girls. Participants were 528 girls, aged 14-18 years, recruited as part of a larger online study on LGBTQ + adolescent health. Participants anonymously completed self-report measures of parent-adolescent relationship quality, sexual orientation-based victimization, body esteem, and DE behaviors, including binge eating, purging, and caloric restriction. Parent-adolescent relationship quality was positively associated with SM adolescent girls' body esteem, and some aspects of body esteem subsequently mediated the associations between parent-adolescent relationship quality and DE behaviors. Experiences of sexual orientation-related victimization were also positively related to endorsement of caloric restriction. However, no significant indirect effects were observed between sexual orientation-related victimization and DE via body esteem. These results suggest parents could influence their SM daughters' DE behaviors via body esteem, and SM girls may be engaging in caloric restriction if they experience victimization, regardless of their body esteem., Competing Interests: Declaration of Competing Interest This study was funded in part by the University of Pittsburgh Central Research Development Fund through an award to Drs. Salk, Thoma, and Choukas-Bradley. Dr. Thoma was supported by NIMH grants K01 MH117142 and T32 MH018951, and Dr. Salk was supported by NIMH grant T32 MH018269. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. 1940700 awarded to Anne J. Maheux. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of NSF or NIH, and these organizations had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Sharing "selfies" on social media is common among adolescents. The frequency with which adolescents post selfies may be less important than behaviors and cognitions underlying selfie-posting, and these practices may differ by gender. This multi-method study explored selfie practices in a school-based sample of 639 adolescents ( M age =17.6; 53.5% female). Participants completed self-report measures of selfie practices, body esteem, depressive symptoms, and peer behaviors. In addition, a subset of participants' social media pages ( n = 245) were observationally-coded for numbers of selfies, followers, and likes. Factor analyses revealed two distinct selfie practices: selfie appearance investment and selfie peer feedback concern . Girls posted selfies more frequently, and reported greater levels of appearance investment and concern over peer feedback on selfies compared to boys. Multiple group structural equation models indicated that for boys and girls, selfie appearance investment was associated with depressive symptoms. For girls only, selfie peer feedback concern was associated with excessive reassurance-seeking and lower body esteem. No associations were revealed between observationally-coded measures of selfie-posting frequency and psychosocial outcomes. Overall, findings suggest that frequency of selfie-posting may be less relevant for understanding adolescent adjustment than investment in and concern over the selfie-posting experience., Competing Interests: Disclosures: The authors have no conflicts of interest to disclose.

During the COVID-19 pandemic, some ways of using social media-such as directly communicating with friends-may have helped adolescents thrive. We examined longitudinal associations between high school adolescents' social media use and gratitude across a 15-month period before and during the pandemic (n = 704, M age  = 15.10; 52% girls). The trajectories of gratitude and the importance of social media for meaningful conversations with friends-but not frequency of social media use-were positively associated over time. At the within-person level, gratitude predicted increased importance of social media for meaningful conversations, but not vice-versa. Findings suggest that gratitude may be associated with and may motivate using social media to foster social connection, but may not increase overall social media use., (© 2021 The Authors. Journal of Research on Adolescence published by Wiley Periodicals LLC on behalf of Society for Research on Adolescence.)

Objective: Adolescence is a developmental period of increased risk for disordered eating. Gender minority adolescents (GMAs), or those whose gender identity does not align with their sex assigned at birth, may experience body image concerns related to unique gender-related stressors. GMAs may use disordered eating to affirm a feminine, masculine, or nonbinary gender identity. However, little is known about differences in disordered eating between GMAs and cisgender adolescents. Therefore, this study had two primary goals: (a) to compare disordered eating between GMAs and cisgender adolescents by examining the role of gender identity and sex assigned at birth; and (b) within GMAs, to examine associations between gender identity congruence and disordered eating., Method: A large U.S. sample of GMAs and cisgender adolescents (n = 1,191 GMAs; 919 cisgender; M age = 15.93 years) reported their disordered eating on an anonymous online survey., Results: A MANOVA revealed a significant interaction between gender identity and sex assigned at birth. Follow-up ANOVAs demonstrated that purging, caloric restriction, excessive exercise, and muscle building differed as a function of gender identity and sex assigned at birth. Among GMAs, a multiple multivariate regression model demonstrated that disordered eating was lower among participants who reported greater gender identity congruence., Discussion: GMAs should not be considered a homogenous group, as differences in gender identity may lead to the internalization of different appearance ideals and disparate eating disorder symptomatology. Results suggest that clinicians working with GMAs consider the unique body image concerns that could accompany a specific gender identity., (© 2021 Wiley Periodicals LLC.)

Although prior work indicates an association between idealized media content and adolescents' body-related concerns, such as self-objectification, body comparison, and body shame, few prior studies have examined the role of pornography. Even fewer studies have included adolescent girls, limiting our understanding of potential gender differences. In this brief report, we investigate these associations in a diverse mixed-gender sample of high school students in the Southeastern U.S. (n = 223, ages 15-18, M age = 16.25, 59 % girls) who completed computerized self-report measures. Controlling for demographic covariates and frequency of social media use, we found an association between frequency of pornography consumption in the past year and higher self-objectification and body comparison, but not body shame. No evidence of differences by gender emerged. Results suggest that both boys and girls may be susceptible to pornography-related body concerns, yet these concerns may not include body shame. Future research should examine both risks and benefits of pornography use among adolescents using longitudinal designs, as well as how body-related concerns can be incorporated into pornography literacy interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Transgender adolescents (TGAs) face many of the same sociocultural and biological influences on body dissatisfaction and disordered eating as cisgender peers. Additionally, TGAs experience unique body- and gender-related concerns. The purpose of this study is to explore the nuances of gender identity, gender transitioning, body image, and disordered eating among TGAs. Case summaries and a synthesis of key themes are presented from interviews with nine TGAs aged 16-20 (M age = 17). All participants reported engaging in at least one behavior to change their weight or shape. Consistent with a theoretical biopsychosociocultural model we proposed, TGAs described body dissatisfaction and disordered eating related to transgender-specific factors (e.g., behaviors aimed at minimizing secondary sex characteristics) and broader developmental and sociocultural factors. Some participants reported improvements in body image and disordered eating following gender transition. The interviews highlight complex associations among gender identity, gender transitioning, body image, and disordered eating during adolescence, suggesting that disentangling transgender-specific factors from other individual factors is difficult. These findings may guide future research on the prevalence and functions of disordered eating among TGAs and point to a unique set of needs for effective detection and treatment of concurrent gender incongruence, body dissatisfaction, and disordered eating., Competing Interests: Declarations of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Two randomized-controlled studies explored the feasibility, acceptability, and efficacy of the EVERYbody Project, a gender-inclusive, diversity-focused, dissonance-based body image intervention for college students., Method: Trial 1 (N = 98; 80% female, 14% male, and 6% gender-expansive) piloted the two-session intervention delivered by an expert (faculty or staff) and peer cofacilitators compared to a waitlist control. Trial 2 (N = 141; 79% female, 15% male, and 6% gender-expansive) utilized peer leaders, comparing the EVERYbody Project to a video and expressive writing intervention. Around half of the participants in both trials self-identified in one or more specific marginalized identity category. Changes in eating disorder symptoms and risk factors were assessed through 1-month follow-up. Trial 1 also assessed the intervention's impact on students with marginalized identities through qualitative interviews., Results: In Trial 1, the EVERYbody Project produced greater reductions in eating disorder symptoms, internalized appearance norms, body dissatisfaction, and negative affect compared to the waitlist control through 1-month follow-up, with medium effect sizes. The impact was similar in students with marginalized and majority identities, and qualitative interviews suggested specific positives of the intervention. In Trial 2, there were significant changes in two of four outcomes for participants in the EVERYbody Project compared to the video and expressive writing intervention, but overall, the intervention impact was modest., Conclusions: The EVERYbody Project is a feasible and acceptable inclusive dissonance-based body image program. It appears to be beneficial when delivered via experts, but research is needed to establish whether the program can be delivered using peer leaders with greater impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adolescence is a developmental period during which youth tend to initiate sexual behavior, which may include sexual risk behavior. Symptoms of borderline personality disorder (BPD) are associated with increased rates of risky behaviors. However, little is known about longitudinal associations between BPD symptoms and sexual risk behaviors during adolescence. This study examines developmental trajectories of adolescent girls' BPD symptoms and sexual risk behaviors in a community sample of Black and White girls from the Pittsburgh Girls Study (n = 1620). Dual trajectory modeling provided insights into the temporal precedence and co-development of BPD symptoms and sexual risk behaviors from ages 14 to 18. In order to examine the unique association between BPD symptoms and sexual risk behaviors, analyses controlled for symptoms of depression and conduct disorder, as well as race, sexual orientation, and pubertal development. Girls with more BPD symptoms at age 14 showed steeper growth over time in sexual risk behaviors from ages 14 to 18. Additionally, adolescents who showed steeper increases in BPD symptoms over time also showed steeper increases in sexual risk behaviors across adolescence. Notably, however, sexual risk behavior at age 14 was not significantly associated with longitudinal trajectories of BPD symptoms. Results suggest that adolescent girls with early symptoms of BPD are at heightened risk for the development of sexual risk behaviors during adolescence, while the reverse association does not hold. Implications for adolescent development and sexual risk behavior are discussed.

Objective: This pilot study tested counselor access to participants' digital self-monitoring (SM) data as a means of improving long-term lifestyle modification (LM) outcomes., Methods: After 12 weeks of weight-loss treatment, participants (N = 77) were randomized to LM or LM+SHARE for weeks 13 to 52. All participants received monthly phone calls and weekly text messages from weeks 13 to 52 and were instructed to engage in daily digital SM of weight, eating, and exercise. In LM+SHARE, but not LM, counselors had access to SM device data. Assessments were conducted as weeks 0, 13, 26, and 52., Results: Retention, engagement, and treatment satisfaction were excellent. LM+SHARE participants, compared with LM, had more frequent SM of weight and eating. Weight loss continued at a similar rate in both conditions from weeks 13 to 26. From weeks 26 to 52, those in LM regained approximately 2 kg, whereas those in LM+SHARE maintained weight loss, a significant difference. Nonetheless, total weight loss did not significantly differ by condition. Engagement in dietary SM mediated the effect of condition on weight., Conclusions: Counselor access to SM data is feasible and acceptable. Additional research is warranted to determine whether it can meaningfully improve outcomes., (© 2020 The Obesity Society.)

Recent stroke studies have shown that the ipsi-lesional thalamus longitudinally and significantly decreases after stroke in the acute and subacute stages. However, additional considerations in the chronic stages of stroke require exploration including time since stroke, gender, intracortical volume, aging, and lesion volume to better characterize thalamic differences after cortical infarct. This cross-sectional retrospective study quantified the ipsilesional and contralesional thalamus volume from 69 chronic stroke subjects' anatomical MRI data (age 35-92) and related the thalamus volume to time since stroke, gender, intracortical volume, age, and lesion volume. The ipsi-lesional thalamus volume was significantly smaller than the contra-lesional thalamus volume (t(68) = 13.89, p < 0.0001). In the ipsilesional thalamus, significant effect for intracortical volume (t(68) = 2.76, p = 0.008), age (t(68) = 2.47, p = 0.02), lesion volume (t(68) = - 3.54, p = 0.0008), and age*time since stroke (t(68) = 2.46, p = 0.02) were identified. In the contralesional thalamus, significant effect for intracortical volume (t(68) = 3.2, p = 0.002) and age (t = - 3.17, p = 0.002) were identified. Clinical factors age and intracortical volume influence both ipsi- and contralesional thalamus volume and lesion volume influences the ipsilesional thalamus. Due to the cross-sectional nature of this study, additional research is warranted to understand differences in the neural circuitry and subsequent influence on volumetrics after stroke.

Objective: Right cerebellar-left frontal (RC-LF) white matter integrity (WMI) has been associated with working memory. However, prior studies have employed measures of working memory that include processing speed and attention. We examined the relationships between the RC-LF WMI and processing speed, attention, and working memory to clarify the relationship of RC-LF WMI with a specific cognitive function. Right superior longitudinal fasciculus II (SLF II) WMI and visual attention were included as a negative control tract and task to demonstrate a double dissociation., Methods: Adult survivors of childhood brain tumors [n = 29, age: M = 22 years (SD = 5), 45% female] and demographically matched controls were recruited (n = 29). Tests of auditory attention span, working memory, and visual attention served as cognitive measures. Participants completed a 3-T MRI diffusion-weighted imaging scan. Fractional anisotropy (FA) and radial diffusivity (RD) served as WMI measures. Partial correlations between WMI and cognitive scores included controlling for type of treatment., Results: A correlational double dissociation was found. RC-LF WMI was associated with auditory attention (FA: r = .42, p = .03; RD: r = -.50, p = .01) and was not associated with visual attention (FA: r = -.11, p = .59; RD: r = -.11, p = .57). SLF II FA WMI was associated with visual attention (FA: r = .44, p = .02; RD: r = -.17, p = .40) and was not associated with auditory attention (FA: r = .24, p = .22; RD: r = -.10, p = .62)., Conclusions: The results show that RC-LF WMI is associated with auditory attention span rather than working memory per se and provides evidence for a specificity based on the correlational double dissociation.

Objective: Midlife women experience elevated risk for cardiovascular disease and often receive advice to increase physical activity to mitigate this risk. Use of accelerometers to measure ambulatory physical activity requires selection of appropriate thresholds for estimating moderate-to-vigorous physical activity (MVPA), and choice of cut points may lead to meaningfully different conclusions about midlife women's physical activity (PA) engagement. This is particularly important given the recent elimination of 10-minute bout requirements for MVPA. This two-phase study examined differences between four cut point methods among midlife women with cardiovascular disease (CVD) risk. We used findings from Study 1 (exploratory) to generate hypotheses for Study 2 (confirmatory)., Methods: Across studies, participants (N = 65) were midlife women with an additional CVD risk factor (eg, hypertension). Participants wore waistband accelerometers for seven days. Daily totals were calculated for minutes in light and MVPA using four common quantification methods (Freedson, Matthews, Swartz, and Troiano)., Results: Multilevel models showed meaningful differences between methods (P < 0.0001). For total (non-bouted) minutes of MVPA, Freedson and Troiano methods showed that participants barely met MVPA recommendations (30 min per day), whereas Matthews and Swartz methods showed that participants greatly exceeded this goal. As differences between methods were smaller using MVPA bouts of 10 minutes or more (though remained significant), the observed variation was due in part to small bursts of MVPA dispersed throughout the day., Conclusions: Findings demonstrate the need for careful consideration of PA quantification among midlife women with CVD risk, and for further investigation to determine the most appropriate quantification method. : Video Summary:http://links.lww.com/MENO/A545.

Blood Oxygen Level Dependent (BOLD) functional MRI is a complex neurovascular signal whose magnitude depends on baseline physiological factors such as cerebral blood flow (CBF). Because baseline CBF varies across the brain and is altered with aging, the interpretation of stand-alone aging-related BOLD changes can be misleading. The primary objective of this study was to develop a methodology that combines task fMRI and arterial spin labeling (ASL) techniques to sensitize task-induced BOLD activity by covarying out the baseline physiology (i.e., CBF) in an aging model. We recruited 11 younger and 13 older healthy participants who underwent ASL and an overt language fMRI task (semantic category member generation). We measured in-scanner language performance to investigate the effect of BOLD sensitization on BOLD-behavior relationships. The results demonstrate that our correction approach is effective at enhancing the specificity and sensitivity of the BOLD signal in both groups. In addition, the correction strengthens the statistical association between task BOLD activity and behavioral performance. Although CBF has inherent age dependence, our results show that retaining the age factor within CBF aides in greater sensitization of task fMRI signals. From a cognitive standpoint, compared to young adults, the older participants showed a delayed domain-general language-related task activity possibly due to compromised vessel compliance. Further, assessment of functional evolution of corrected BOLD activity revealed biphasic BOLD dynamics in both groups where BOLD deactivation may reflect greater semantic demand or increased premium on domain general executive functioning in response to task difficulty. Although it was promising to note that the predictability of behavior using the proposed methodology outperforms other methodologies (i.e., no correction and normalization by division), and provides moderate stability and adequate power, further work with a larger cohort and other task designs is necessary to improve the stability of predicting associated behavior. In summary, we recommend correction of task fMRI signals by covarying out baseline CBF especially when comparing groups with different neurovascular properties. Given that ASL and BOLD fMRI are well established and widely employed techniques, our proposed multi-modal methodology can be readily implemented into data processing pipelines to obtain more accurate BOLD activation maps., (Copyright © 2020 Krishnamurthy, Krishnamurthy, Drucker, Kundu, Ji, Hortman, Roberts, Mammino, Tran, Gopinath, McGregor, Rodriguez, Qiu, Crosson and Nocera.)

Background: Most adults with overweight/obesity participating in behavioural weight loss (BWL) programmes never achieve prescribed physical activity (PA) levels. This study examined changes in PA barriers, their relationships with accelerometer-measured PA during and after a 12-month BWL programme, and associations between PA barriers and participant characteristics., Methods: Adults (N = 283) in a BWL programme completed the Barriers to Being Active Quiz, a 21-item self-report measure that assesses seven perceived PA barriers, and they wore an accelerometer for seven consecutive days at baseline and at 6 (midtreatment), 12 (end of treatment), 18 (6-mo follow-up), and 24 months (12-mo follow-up). Weight and height were measured, and demographic information was collected at baseline., Results: Repeated-measures analyses of variance (ANOVAs) revealed a significant quadratic effect of time on total PA barriers, P  < .001, such that PA barriers decreased by midtreatment, remained below baseline levels by end of treatment, but increased to near-baseline levels by follow-up. Perceived PA barriers were negatively associated with baseline moderate-to-vigorous PA (MVPA), P  < .001, and decreases in perceived PA barriers were related to greater MVPA at 6 ( P  = .004), 12 ( P  < .001), and 24 months ( P  = .007). Participants who were younger, P  = .02, and white, P  = .009, reported more baseline barriers., Conclusions: Perceived PA barriers meaningfully decreased during BWL treatment, which in turn was associated with greater MVPA. This pattern suggests that, on average, BWL effectively addresses perceived PA barriers, which contributes to increased PA. Future research should identify interventions to maintain decreases in barriers after end of treatment., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (© 2019 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Objective: Digital self-monitoring of eating, physical activity, and weight is increasingly prescribed in behavioural weight loss programmes. This study determined if adherence rates or associations with outcomes differed according to self-monitoring target (ie, self-monitoring of eating versus physical activity versus weight)., Methods: Participants in a 3-month, group-based weight loss programme were instructed to use an app to record food intake, wear a physical activity sensor, and use a wireless body weight scale. At post-treatment, weight loss was measured in clinic and moderate-to-vigorous physical activity (MVPA) was measured by research-grade accelerometer., Results: Adherence to self-monitoring decreased significantly over time for eating and weight but not physical activity. Overall, adherence to self-monitoring of weight was lower than that of eating or physical activity. Greater adherence to self-monitoring of eating, physical activity, and weight each predicted greater weight loss. Only greater adherence to self-monitoring of eating was associated with greater bouted minutes of MVPA., Conclusions: Findings from this study suggest that self-monitoring should be considered a target-specific behaviour rather than a unitary construct when conceptualizing adherence and association with treatment outcomes., Competing Interests: The authors declared no conflict of interest., (© 2019 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Introduction: Individuals with overweight or obesity often experience stigmatizing weight-related interactions in health care, though how these experiences are associated with body mass index (BMI) and eating behaviour is unknown. This study had three aims: (a) characterize types and frequency of stigmatizing health care experiences, (b) assess relationships among BMI, eating behaviour, and stigmatizing experiences, and (c) examine whether internalized weight stigma mediates the relationship between stigmatizing experiences, weight, and eating behaviour., Methods: Adults (N = 85) enrolled in behavioural weight loss completed measures of stigmatizing health care experiences, weight bias internalization, eating behaviours, and BMI. Cross-sectional correlational and mediational analyses were conducted., Results: The majority (70.6%) of participants reported at least one stigmatizing health care experience in the past year. Greater amounts of stigmatizing experiences were associated with higher BMI ( r = 0.32, P < .01) and greater uncontrolled ( r = 0.22, P  = .04) and emotional eating ( r = 0.28, P < .01). Internalized weight stigma significantly mediated the relationship between stigmatizing experiences and maladaptive eating., Conclusion: Experiences of health care weight stigma were associated with eating behaviour and BMI. Participants with a higher BMI or greater maladaptive eating behaviours may be more susceptible to stigmatizing experiences. Reducing internalized weight stigma and health care provider stigma may improve patient health outcomes., Competing Interests: No conflicts of interest to report., (© 2019 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.)

Depressive symptoms and binge eating are both prevalent in weight management populations and may be associated with reduced benefit from behavioral weight loss, including higher attrition, more perceived barriers, lower weight loss, and increased weight regain. These two potential risk factors for poor behavioral weight loss outcomes may also be associated with each other as depressive symptoms may trigger binge eating, and binge eating-related distress could increase depressive symptoms. The depressive symptom-binge eating link has not been well studied in weight management samples, and psychological processes involved in this relationship have not yet been elucidated. Psychological flexibility, an individual's ability to be connected with and conscious of the present moment and to engage in values-consistent behavior even in the presence of difficult internal experiences, may be one psychological process that changes the depressive symptom-binge eating relationship. High psychological flexibility may be a protective factor in the association of depressive symptoms with binge eating. This study examined the relationship between depressive symptom and binge eating and a potential interactive role of psychological flexibility. Participants (N = 468, 76% female) completed self-report questionnaires of binge eating, depressive symptoms, and psychological flexibility at baseline prior to initiating behavioral weight loss. Depressive symptoms were positively associated with binge eating ( B = 1.00, p < 0.001). Psychological flexibility had an interactive role ( B = -0.03, p = 0.005). Among participants with minimal to mild depressive symptoms, those with higher psychological flexibility had less severe binge eating. Findings suggest that psychological flexibility may be a protective factor in the association between depressive symptoms and binge eating in the majority of individuals initiating behavioral weight loss. Psychological flexibility is a psychological process to consider targeting for enhancing efficacy of weight loss treatment, especially among individuals with minimal to mild depressive symptoms and binge eating behavior., Competing Interests: Declaration of interests Drs. Butryn, Forman, and Sherwood receive grants from the National Institutes of Health for the current study and related research. Dr. Forman and Dr. Butryn receive royalties from editing and authoring books on acceptance-based treatment for weight management. We certify that all authors otherwise have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript (e.g., employment, consultancies, stock ownership, honoraria).