Stigmatizing effects of weight status on lay perceptions of eating disorder-related distress.

The present study examined how weight status would affect lay perceptions of a White female student presenting signs of eating disorder-related distress. We recruited a mixed-gender, weight-diverse U.S. community sample through Mechanical Turk (N = 130; 49.2% female) to complete an online survey. Participants were randomly assigned to one of two conditions in which they read a personal statement section of a college application revealing eating disorder-related distress from a student who was either 'overweight' or 'underweight.' Participants evaluated the student on need for support, behavioural prescriptions for eating and exercise, and personal qualities. Although participants recognized a serious mental health concern in both conditions, they were more likely to prescribe eating disorder behaviors to the higher weight student. Findings suggest that weight stigma may bias lay perceptions of and even reinforce an eating disorder when exhibited by higher weight individuals.

Intuitive eating is connected to self-reported weight stability in community women and men.

Professionals working in eating disorder prevention, treatment, and public health aim to improve eating behaviors to stabilize weight, which is more adaptive for health and well-being than weight variation. However, it is unknown which eating behaviors are linked to weight stability in non-intervention samples. This study examines how intuitive eating and eating restraint (flexible and rigid control) are linked to retrospective reports of weight stability (i.e., maintained weight) and instability (i.e., lost, gained, or cycled weight) during the past year. Community women (n = 192) and men (n = 190) completed online self-report measures of eating behaviors and weight patterns. Intuitive eating was linked to greater weight stability, whereas rigid and flexible control were linked to greater weight instability. Additional research is required to assess the directionality of these associations. Nevertheless, these findings provide preliminary support and clinical implications for the promotion of intuitive eating in prevention and public health contexts.

Perceptions of male partner pressure to be thin and pornography use: Associations with eating disorder symptomatology in a community sample of adult women.

OBJECTIVE: Partner-specific factors have been neglected in eating disorder (ED) research. The present study examined two partner-specific variables that were hypothesized to be linked to women's ED symptoms: perceived male partner thinness-related pressures and pornography use. METHOD: Community women (N = 409) in relationships with men completed online anonymous measures of ED symptomatology, perceptions of male partner thinness-related pressure and pornography use, and thin-ideal internalization. RESULTS: Partner thinness-related pressure was related to higher ED symptomatology, adjusting for age and thinness-related pressures from media, friends, and family. Current and previous partner pornography use were related to higher ED symptomatology, adjusting for age and women's reports of being bothered by this use. Partner thinness-related pressure and previous partner pornography use were associated with ED symptomatology both directly and through thin-ideal internalization, whereas current partner pornography use was directly associated with ED symptomatology. DISCUSSION: Perceptions of male partner thinness-related pressure and pornography use constitute unique factors associated with women's ED symptomatology that may operate indirectly by positioning women to endorse thinness as a personal standard and directly (e.g., by trying to accommodate their partner's appearance preferences). This study's findings provide initial support for pursuing subsequent investigations to test these partner variables as ED risk factors.

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program.

Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.

A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial.

Weight loss is the primary recommendation for health improvement in individuals with high body mass index (BMI) despite limited evidence of long-term success. Alternatives to weight-loss approaches (such as Health At Every Size - a weight-neutral approach) have been met with their own concerns and require further empirical testing. This study compared the effectiveness of a weight-neutral versus a weight-loss program for health promotion. Eighty women, aged 30-45 years, with high body mass index (BMI ≥ 30 kg/m(2)) were randomized to 6 months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, dietary risk, fruit and vegetable intake, intuitive eating, and physical activity. Intention-to-treat analyses were performed using linear mixed-effects models to examine group-by-time interaction effects and between and within-group differences. Group-by-time interactions were found for LDL cholesterol, intuitive eating, BMI, weight, and dietary risk. At post-intervention, the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI, weight, and larger (albeit temporary) decreases in dietary risk. Significant positive changes were observed overall between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach. The trial positions weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight.

The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples.

Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study.

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.

Is intuitive eating the same as flexible dietary control? Their links to each other and well-being could provide an answer.

Researchers have found that rigid dietary control is connected to higher psychological distress, including disordered and disinhibited eating. Two approaches have been touted by certain scholars and/or health organizations as healthier alternatives: intuitive eating and flexible control-yet these approaches have not been compared in terms of their shared variance with one another and psychological well-being (adjustment and distress). The present study explored these connections among 382 community women and men. Findings revealed that intuitive eating and flexible control are inversely related constructs. Intuitive eating was related to lower rigid control, lower psychological distress, higher psychological adjustment, and lower BMI. In contrast, flexible control was strongly related in a positive direction to rigid control, and was unrelated to distress, adjustment, and BMI. Further, intuitive eating incrementally contributed unique variance to the well-being measures after controlling for both flexible and rigid control. Flexible control was positively associated with psychological adjustment and inversely associated with distress and BMI only when its shared variance with rigid control was extracted. Collectively, these results suggest that intuitive eating is not the same phenomenon as flexible control, and that flexible control demonstrated substantial overlap and entanglement with rigid control, precluding the clarity, validity, and utility of flexible control as a construct. Discussion addresses the implications of this distinction between intuitive eating and flexible control for the promotion of healthy eating attitudes and behaviors.

The developmental effects of media-ideal internalization and self-objectification processes on adolescents' negative body-feelings, dietary restraint, and binge eating.

Despite accumulated experimental evidence of the negative effects of exposure to media-idealized images, the degree to which body image, and eating related disturbances are caused by media portrayals of gendered beauty ideals remains controversial. On the basis of the most up-to-date meta-analysis of experimental studies indicating that media-idealized images have the most harmful and substantial impact on vulnerable individuals regardless of gender (i.e., "internalizers" and "self-objectifiers"), the current longitudinal study examined the direct and mediated links posited in objectification theory among media-ideal internalization, self-objectification, shame and anxiety surrounding the body and appearance, dietary restraint, and binge eating. Data collected from 685 adolescents aged between 14 and 15 at baseline (47 % males), who were interviewed and completed standardized measures annually over a 3-year period, were analyzed using a structural equation modeling approach. Results indicated that media-ideal internalization predicted later thinking and scrutinizing of one's body from an external observer's standpoint (or self-objectification), which then predicted later negative emotional experiences related to one's body and appearance. In turn, these negative emotional experiences predicted subsequent dietary restraint and binge eating, and each of these core features of eating disorders influenced each other. Differences in the strength of these associations across gender were not observed, and all indirect effects were significant. The study provides valuable information about how the cultural values embodied by gendered beauty ideals negatively influence adolescents' feelings, thoughts and behaviors regarding their own body, and on the complex processes involved in disordered eating. Practical implications are discussed.

Living while fat: Development and validation of the Fat Microaggressions Scale.

Fat microaggressions are microlevel social practices in the form of commonplace everyday indignities that insult fat people and have been documented anecdotally and qualitatively. However, no psychometrically validated scale exists for measuring fat microaggressions, despite decades of microaggression research demonstrating their negative health associations. This research describes the development and construct validation of the Fat Microaggressions Scale across four studies. Study 1 focused on item development through a systematic review, qualitative analysis of Tweets using #fatmicroaggressions, and a Delphi review. Study 2 (N = 343) determined that a four-factor structure was appropriate in an online community sample of fat adults. Study 3 (N = 410) confirmed the factor structure in a new online sample of fat adults and provided initial evidence of construct validity. Study 4 (N = 197) found evidence of test-retest reliability and demonstrated additional construct validity. Our findings offer a newly validated quantitative measure of fat microaggressions and an initial framework for naming and categorizing these experiences, which may be used to advance the study of fat microaggressions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objects don't object: evidence that self-objectification disrupts women's social activism.

Integrating system-justification and objectification theories, the research reported here broadens the scope of prior work on women's self-objectification to examine its system-justifying function. I investigated the relation of trait and state self-objectification to support for the gender status quo and engagement in gender-based social activism among U.S. college women. Study 1 established that greater trait self-objectification was related to more gender-specific system justification and less engagement in gender-based social activism. The data supported a mediational model in which gender-specific system justification mediated the link between trait self-objectification and social activism. Results from Study 2, in which self-objectification was situationally activated, confirmed the same mediational model. These findings suggest that trait and state self-objectification may be part of a wider pattern of system-justifying behavior that maintains gender inequality and thwarts women's pursuit of social justice.

Effects of online self-compassionate writing on stigmatizing and affirming self-perceptions: Potential boundary conditions in undergraduate women.

This study investigated the effects of an online self-compassionate writing intervention on stigmatizing and affirming self-views toward the body in a sample of college women (N = 254). Participants were randomly assigned to a self-compassionate writing, attentional-control writing, or wait-list control condition for one week, and completed measures of self-compassion, affirming self-perceptions, and stigmatizing self-perceptions at baseline, one-week post intervention, and one-month post intervention. A series of mixed AN(C)OVAs revealed no significant effects by condition or time on stigmatizing or affirming self-views toward the body when controlling for self-esteem, internalized weight stigma, and eating disorder symptomatology. Follow-up exploratory analyses demonstrated no significant effects by condition on the six facets of self-compassion. Notably, participants were significantly more likely to drop out from the study over time if they were lower in self-compassion and self-esteem, and higher in internalized weight stigma at baseline. These results suggest that online self-compassion writing interventions may need to be longer and more potent, especially for women with more entrenched and stigmatized views about their bodies, as well as potential boundary conditions of cultivating self-compassion in a short-term online intervention.

Integrating social media variables as predictors, mediators, and moderators within body image frameworks: Potential mechanisms of action to consider in future research.

In this article, we consider how social media variables may be integrated as predictors, mediators, and moderators within dominant theoretical frameworks of body image in order to identify potential mechanisms of action that can be empirically examined in future research and used to direct prevention and intervention efforts. To achieve this goal, we first articulate social media variables that have been investigated as predictors, mediators, and moderators in body image research. Next, we present the following critical and sociocultural theoretical frameworks: social comparison theory, tripartite influence model, objectification theory, developmental theory of embodiment, acceptance model of intuitive eating, cultivation theory, and uses and gratifications theory. Additionally, we present the theory of development of critical body awareness, a newly developed model that may provide further insight regarding the relationships between social media and body image-related outcomes. For each model, we articulate extant research that has explored social media variables within its context and explicate how social media variables could potentially be studied as predictors, mediators, and moderators within its structure. To conclude, we address pertinent limitations and gaps within this research space that could direct future research across the theoretical frameworks.

Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review.

Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Dysfunctional exercise (DEX) is a symptom of eating disorders (ED) that precedes, maintains and exacerbates ED pathology. Health professionals struggle to clinically address and manage DEX as little information is available about its assessment and safe management. The current review provides a comprehensive summary of the medical and physiological complications of ED that may be exacerbated by exercise and outlines when exercise may be contraindicated or used in a modified or cautionary way. The literature review yielded six categories of complications: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index.

Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.

Disordered eating symptoms as a function of perceived weight status and race: An intersectional examination.

Disordered eating (DE) exhibited by individuals with intersecting marginalized identities may be less likely to be perceived as pathological compared to DE exhibited by individuals with non-marginalized identities. The present experiment tested the intersectional impact of weight status and race stimuli on responses to DE in a college sample. Undergraduate students (N = 193, Mage = 18.57, SD = 1.88, 71 % female) read a fictional account from a female target with DE who was described as "underweight," "average weight," or "overweight," and "White" or "Black." Participants completed an in-lab survey assessing detection of and responses to DE. Three 2 (race: Black, White) x 3 (weight status: underweight, average weight, overweight) ANCOVAs revealed a main effect of weight status. DE was more likely to be detected in "underweight" than "average" and "overweight" targets (p < .001). Participants encouraged weight loss for "average" and "overweight" targets compared to "underweight" targets (p < .001) and encouraged weight restoration for "underweight" targets compared to "average weight" and "overweight" targets (p < .001). No significant effects for target race or interaction between weight status and race emerged. These findings underscore the salience of weight status in shaping perceptions of DE.

Compliance with COVID-19 safety measures: A test of an objectification theory model.

In the present paper, we tested an objectification theory model including compliance with COVID-19 safety measures as an outcome. Safety measures recommended by governments and health organizations include monitoring one's body and interpersonal and social distance from others. We contend that the diffuse safety anxiety stemming from sexual and self-objectification encourages targets to broadly adopt behaviors that protect against body-based dangers, including COVID-19. Accordingly, safety anxiety should predict greater compliance with COVID-19 safety measures. U.S. residents (N = 501) were recruited online and completed measures of sexual objectification, self-objectification, safety anxiety, appearance anxiety, and COVID-19 safety compliance. Two-step mediation analyses revealed a positive indirect effect of sexual objectification on safety anxiety through internalization of observers' perspectives (self-objectification Factor 1); in turn, there was a positive indirect effect of internalized others on COVID-19 body-based safety compliance through safety anxiety. Moreover, women (vs. men) reported higher levels of sexual objectification, internalization of observers' perspectives, safety anxiety, appearance anxiety, and COVID-19 safety measure compliance. Not only is safety anxiety relevant to cautionary behaviors protective against sexual objectification threat, but it also predicts compliance with measures that reduce the risk of contracting COVID-19. Implications for objectification theory are discussed.

Psychometric properties and validation of the Phenomenological Body Shame Scale - Revised (PBSS-R).

Body shame is a common experience among women yet a challenging phenomenon to operationalize, and measures of body shame often fail to capture its embodied aspects. In this article, we examined the structural and psychometric properties of an existing measure of body shame that was developed by Fredrickson et al. (1998) to assess the motivational and behavioral components of feeling body shame. Across three studies, women participants completed the Phenomenological Body Shame Scale (PBSS) and measures of theoretically related constructs in counterbalanced order via online survey platforms. The results demonstrate evidence of construct validity for an abbreviated, 8-item measure of phenomenological body shame (PBSS-R). In Study 1 (n = 341 community women), we evaluated and confirmed the scale's structural validity as a unidimensional measure. In Study 2 (n = 204 college women), we demonstrated positive associations between the PBSS-R and negative body image attitudes and behaviors, and negative associations with self-compassion, supporting the scale's external validity. In Study 3 (n = 235 community women), the PBSS-R explained variance in intuitive eating and happiness above theoretically related measures of self-objectification and body shame, supporting the scale's incremental validity. We recommend use of this abbreviated measure to assess the more embodied and less evaluative features of body shame in women.

Smile pretty and watch your back: Personal safety anxiety and vigilance in objectification theory.

[Correction Notice: An Erratum for this article was reported online in Journal of Personality and Social Psychology on Nov 19 2020 (see record 2020-89294-001). In Table 4, the mean, standard deviation, and range for the Personal Safety Anxiety and Vigilance (PSAVS) variable were incorrect.] Objectification Theory posits that everyday encounters with sexual objectification carry a diffuse nonspecific sense of threat that engenders personal safety anxiety in women. In this article, we provide direct evidence for this tenet across 5 studies and 1,665 participants using multiple methods. Study 1 (N = 207) and Study 2 (N = 161) explored and confirmed the factor structure of the Personal Safety Anxiety and Vigilance Scale (PSAVS), a measure of personal safety anxiety, and provided evidence for the reliability and construct validity of its scores. Study 3 (N = 363) showed that personal safety anxiety is a conceptually different construct for women and men, and differentially mediated the relation between sexual objectification and restricted freedom of movement and the relation between self-objectification and restricted freedom of movement for women and men. Study 4 (N = 460) included a comprehensive test of personal safety anxiety within an expanded Objectification Theory model, which supported personal safety anxiety as a mediator of the links from sexual and self-objectification to women's restricted freedom of movement. Study 5 (N = 474) replicated these results while also adjusting for specific fears of crime and rape. Our findings offer a newly validated assessment tool for future research on safety anxiety, illuminate the real and lasting sense of threat engendered by everyday sexual objectification, and broaden understanding of the mental and physical constraints on women's lived experiences posited in Objectification Theory. (PsycInfo Database Record (c) 2022 APA, all rights reserved).