Enhancing inferences and conclusions in body image focused non-experimental research via a causal modelling approach: A tutorial.

Causal inference is often the goal of psychological research. However, most researchers refrain from drawing causal conclusions based on non-experimental evidence. Despite the challenges associated with producing causal evidence from non-experimental data, it is crucial to address causal questions directly rather than avoiding them. Here we provide a clear, non-technical overview of the fundamental concepts (including the counterfactual framework and related assumptions) and tools that permit causal inference in non-experimental data, intended as a starting point for readers unfamiliar with the literature. Certain tools, such as the target trial framework and causal diagrams, have been developed to assist with the identification and reduction of potential biases in study design and analysis and the interpretation of findings. We apply these concepts and tools to a motivating example from the body image field. We assert that more precise and detailed elucidation of the barriers to causal inference within one's study is arguably a key first step in the enhancement of non-experimental research and future intervention development and evaluation.

Enhancing understanding of social media literacy to better inform prevention of body image and eating disorders.

Research has revealed an important role for appearance-focused, and in particular photo-based, social media in the development of body image and eating pathology. Social media literacy is a multifaceted construct involving purposeful selection and exposure to social media content and use of protective filtering (deliberately screening and interpreting information in a protective manner), as well as implementing critical skills related to understanding the unrealistic nature of social media content, limiting appearance comparisons with images, and contributing to social media (comments and images) in ways that limit the pursuit of appearance ideals. Previous work has provided partial support for these facets as related to lower levels of body image and eating concerns. However, additional conceptual and measurement work is needed to advance understanding of this protective role and how to foster social media literacy. Although data are scarce, targeting social media literacy in prevention and intervention programs may also be valuable. In this perspective piece, key features that we identify as priorities for future prevention and intervention efforts include developing interventions that target the implementation of social media skills beyond their acquisition. In addition, leveraging social media user generated content for prevention purposes would likely be useful, as would embedding micro-skill delivery within platforms.

A sociocultural model of the relationships between social media use and body image in midlife women.

The use of photo-based social media has been associated with body image concerns among young women. Women in midlife are increasingly experiencing appearance pressures, and these pressures might be particularly strong on social media. However, to date, most of the research on social media use has focused on younger women, and this constitutes an important gap. The purpose of this study was therefore to examine a model of the relationships among social media use and body image among women aged 40 and over. A convenience sample of 192 women aged 40-73 years completed an online survey assessing selfie investment, social media appearance pressures, thin-ideal internalization, appearance comparison, weight and shape concerns, facial satisfaction, drive for youthfulness and drive for muscularity. The final sociocultural model was a good fit to the data, and thin-ideal internalization and appearance comparisons mediated the pathways between the social media variables and the body image ones.

Self-compassion and relationship status moderate the relationship between sexual minority status and body image concerns.

A growing body of research suggests that sexual minority men (SMM) experience greater body image concerns including body shame, body surveillance, drive for muscularity and drive for thinness than heterosexual men. However, little is known regarding the potential factors that can buffer these relationships. The aim of the present study was to examine the role that both self-compassion and relationship status may play in decreasing the strength of the relationship between sexual minority status and body image concerns. A sample of n = 106 SMM and n = 145 heterosexual men completed an online survey assessing body image concerns, self-compassion, and relationship status. Findings revealed that SMM reported higher levels of body image concerns (on all measures, except drive for muscularity) as compared to heterosexual men. Self-compassion moderated the link between sexual orientation and drive for muscularity: in men with higher levels of self-compassion, sexual orientation was no longer associated with drive for muscularity. But, among men with less self-compassion, SMM reported higher drive for muscularity than heterosexual men. Moreover, relationship status moderated the relationship between sexual orientation and body shame and drive for thinness, such that, among SMM only, being in a relationship was associated with lower levels of these concerns.

Exploring longitudinal relationships between fitness tracking and disordered eating outcomes in college-aged women.

OBJECTIVE: A growing body of research, primarily cross-sectional, suggests a relationship between the practice of tracking one's food intake and exercise behaviors using fitness-tracking smartphone applications ("apps") or wearable devices ("wearables") and disordered eating symptomatology. The aim of the present study was to explore longitudinal relationships between fitness tracking and disordered eating outcomes among college-aged women, as well as to determine whether the individual-level risk factors of pre-existing eating concerns, perfectionism, and rumination about food moderated the relationship. METHOD: N = 68 female undergraduates used the MyFitnessPal app for 8 weeks while completing a series of self-report measures. RESULTS: At the trait level, fitness tracking frequency was positively associated with weight/shape concerns, but not with the other outcome measures. Daily levels of fitness tracking did not predict next-day levels for any of the outcome measures. Within-day fitness tracking at one timepoint was associated with lower reports of dietary restraint efforts at the next timepoint. None of the proposed moderators significantly interacted with the relationships over time. DISCUSSION: These results suggest that while those who engage in fitness tracking may experience higher weight/shape concerns as a trait, over time fitness tracking was not associated with an increase in concerns. Further work exploring whether fitness tracking may affect particular subgroups in different ways is warranted.

Sociocultural pressures and engagement with cosmetic products and procedures in adult women.

Previous studies have shown that cosmetic procedures and products that perpetuate Western hegemonic beauty standards among women have become increasingly popular, and pressures from sociocultural agents to utilize them are significant. However, little work has documented the relationship between perceived sociocultural pressures and use of cosmetic procedures and products among a larger age range of adult women. A community sample of 308 women aged 18-66, mean (SD) age of 35.7 (9.7), reported on the cosmetic procedures they had considered or used, as well as perceived pressures from the media, peers, romantic partners, and health and beauty professionals. Findings revealed that, among those investigated, the most frequently utilized products and procedures were supplements and hair removal. However, a significant minority reported considering more invasive procedures, including cosmetic surgery. Media was the predominant source of pressure, while partners were the least frequently endorsed. While pressure from professionals and peers had small-to-moderate associations with utilization of cosmetic products and procedures, pressure from partners had the largest association with their use. This work frames important future directions for examining the impact of sociocultural pressures on women's willingness to utilize cosmetic products and procedures that are sometimes underregulated and risky for physical and mental health.

COVID-19-Related distress, body image, and eating behaviors: a cross-sectional explanatory model.

BACKGROUND: The COVID-19 pandemic has been associated with increased body dissatisfaction and disordered eating behaviors in adolescents. To better understand these associations, this study tested an explanatory model in which appearance-focused social media use, internalization of social media pressure, and mindfulness abilities mediated the relationship between COVID-related distress and body dissatisfaction, which in turn was associated with dietary restraint and binge eating episodes. METHODS: Adolescents (N = 493, Mage= 16.7; 47.5% girls) recruited within high schools completed online measures. We conducted model testing through path analysis in MPlus, using modification indices to derive a well-fitting model. RESULTS: The initially hypothesized model was a poor fit for the data. The final well-adjusted model confirmed several significant paths and supported the parallel mediational roles of social media (specifically, the use of appearance-focused social media and internalization of social media pressure) along with mindfulness, on the relationship between COVID-19-related distress and body satisfaction. Model adjustments involved adding three paths, resulting in two additional significant indirect effects, and suppressing one path. CONCLUSIONS: Findings suggest that mindfulness, media use and the internalization of social media pressure are potential key processes explaining body dissatisfaction and eating disorders among adolescents who experienced higher levels of COVID-related distress.

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

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

Strike a pose: Immediate effects of a model-created social media literacy video on body image and mood.

Exposure to idealized social media imagery has been shown to be detrimental to body image among young women, and social media literacy may be protective. This mixed methods study aimed to evaluate the effects of an online video narrated by a high-profile, plus-size model on the body image and negative mood of young women and predictors of the effects. A sample of 304 young women, average age 20.95 (SD = 2.09) years, completed an online survey including pre- and post-exposure measures of state body image and negative mood, and trait measures of upward social media appearance comparison, thin-ideal internalization, and selfie-investment. A subset (n = 148) responded to open-ended questions to obtain feedback on the video coded categorically and through thematic analysis. Findings revealed immediate improvements in state body satisfaction and negative mood, with higher levels of trait appearance comparison and selfie investment associated with smaller effects of the video. Participants endorsed the video as raising awareness of unrealistic images but limited in terms of mitigating appearance comparison and selfie-investment. Furthermore, participants described that Iskra's status as a professional model also influenced their reactions. These findings highlight the importance of assessing for unintended paradoxical effects of social media literacy efforts and ensuring that such interventions are empirically based.

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

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

Experiences of embodiment during pregnancy and the postpartum period: A qualitative study.

Pregnancy and the postpartum period have been identified as times when women experience important changes in their physical bodies. Yet, little is known about the ways in which these experiences may be related to positive embodiment, or in contrast experienced as restricting and objectifying. Thus, the aim of this study was to qualitatively examine the way in which women experienced embodiment during the course of pregnancy and the postpartum period. Twenty women, mean age (SD)= 31.85, (2.3) years, 95 % White, participated in individual interviews and completed online surveys. Findings revealed that women described experiencing both aspects of positive embodiment including body connection and comfort, agency and functionality, attuned self-care, connection to appetite, and inhabiting the body as a subjective site. Findings also revealed negative aspects including body disconnection and discomfort, disrupted functionality, challenged self-care, appetite suppression, and the body as a public and objectified site. Findings highlight the potential for the pregnancy and postpartum periods to be important times for positive embodiment in women, and a source of appreciation of the body and its functionality. However, social pressures may also constrain embodiment during this period. These findings have implications for identifying pathways to positive embodiment in pregnancy and postpartum.

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

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

Relationships Between Violent Sexual Victimization and Muscle-Building Exercise among Adolescents from the 2019 Youth Risk Behavior Survey.

BACKGROUND: This study aimed to investigate the association between violent sexual victimization and muscle-building exercise among adolescents. METHODS: Cross-sectional data from the 2019 National Youth Risk Behavior Survey (N = 8408) were analyzed. Two indicators of non-dating-related sexual violence (lifetime, past 12 months), along with one indicator of adolescent sexual violence (past 12 months), were assessed. Days of muscle-building in the past week were reported. Multinomial logistic regression analyses were conducted to determine the associations between the three violent sexual victimization variables and muscle-building exercise. RESULTS: Among the sample (50.3% girls), lifetime violent sexual victimization (relative risk ratio [RRR] 1.87, 95% confidence interval [CI] 1.29 to 2.72), past 12-month violent sexual victimization (RRR 1.60, 95% CI 1.15 to 2.22), and past 12-month sexual dating violence (RRR 1.60, 95% CI 1.03 to 2.51) were associated greater relative risk of high engagement (ie, 6 to 7 days) in muscle-building exercise relative to no engagement. CONCLUSIONS: A history of violent sexual victimization is associated with greater involvement in muscle-building exercise, particularly among adolescent girls. Engagement in muscle-building exercise in relation to violent sexual victimization may be a means of emotion regulation and occur due to body dissatisfaction resulting from experiencing violence.

Sociocultural pressures and body related experiences during pregnancy and the postpartum period: A qualitative study.

Sociocultural pressures to pursue unrealistic appearance expectations and control body shape and weight during pregnancy and postpartum periods have been increasing. Little is known about messages from different sources that may constitute unhelpful or protective influences. The aim of this study was to qualitatively examine messages women received from the sociocultural environment during pregnancy and postpartum and their association with experiences of living in their bodies and body change behaviors. Twenty women, mean age (SD)= 31.85, (2.3) years, 95% White, 60% with a Master's degree or higher, participated in individual interviews and completed online surveys. Women described appearance pressure from multiple sources during and after pregnancy, that increased their concerns related to their weight and shape. For a small number, these concerns were associated with efforts to control weight. Others described protective influences from friends and family that promoted body attunement, functionality appreciation, and positive body image. Findings highlight the importance of sociocultural influences during the peripregnancy period yet how many women derive elements of positive body image from this period. These findings have implications for interventions to support body image among women during the peripregnancy period and positive outcomes among mothers and infants.

Association between engagement with appearance and eating related TikTok content and eating disorder symptoms via recommended content and appearance comparisons.

OBJECTIVE: It is well-established that the use of appearance-focused social media is associated with eating disorder (ED) symptoms, due to the presence of idealized imagery. Of concern, social media exposure is increasingly influenced by algorithms, which recommend content based on an analysis of the users' previous patterns of engagement. However, the relationships between users' engagement with social media content based upon its centering of appearance and eating, the presence of these themes in content suggested to them, and their ED symptoms remains unknown. The current study aimed to examine these relationships in the context of TikTok, a video- and algorithm-based platform. METHOD: Undergraduate students (N = 230; 78% female) completed self-report measures of ED symptoms, upwards social media appearance comparisons, as well as a novel measure of TikTok activity. RESULTS: Serial mediation analyses provided support for indirect relationships between engagement with appearance/eating-related content and ED symptoms via higher proportions of appearance/eating-related recommended content and higher levels of upwards social media appearance comparisons, respectively. There was no association between average screen time, nor general tendency to actively engage with content, and either ED symptoms or upwards social media appearance comparisons. DISCUSSION: Findings provide preliminary support for how engagement on TikTok is related to targeted exposure in ways that may contribute to perpetuating and exacerbating ED symptoms. PUBLIC SIGNIFICANCE: Social media use has been consistently associated with greater eating disorder symptoms. However, the ways in which users' engagement with social media content may be related to targeted social media exposure, and in turn eating disorder symptoms, remains unknown. This research provided preliminary evidence for associations between users' engagement with, and targeted exposure to, TikTok content related to appearance and eating, and their eating disorder symptoms.

Involvement in sex work is associated with muscle dysmorphia symptomatology among a sample of Canadian adolescents and young adults.

BACKGROUND: The aim of this study was to investigate the association between lifetime sex work involvement and muscle dysmorphia symptomatology. METHODS: Data from the Canadian Study of Adolescent Health Behaviours (N =912) were analysed. Multiple adjusted linear regression models were estimated with lifetime sex work involvement as the independent variable and muscle dysmorphia symptomatology, measured using the Muscle Dysmorphic Disorder Inventory, as the dependent variable. RESULTS: Among the sample, 3.7% of participants reported engaging in lifetime sex work. Significant associations were found between self-reported lifetime sex work and greater total muscle dysmorphia symptomatology (B =5.03, 95% CI 1.80, 8.26), greater Drive for Size symptomatology (B =2.36, 95% CI 0.74-3.97), and greater Functional Impairment symptomatology (B =2.11, 95% CI 0.54, 3.67), while adjusting for relevant sociodemographic variables. CONCLUSIONS: Findings from this study expand prior research that has documented poor mental health among individuals involved in sex work. Clinical and community health professionals should consider screening for muscle dysmorphia symptomatology among young people who have been involved in sex work.

"Eat more protein, build more muscle": A grounded theory study of muscle-building behaviors among Canadian adolescents and young adults.

Unique risk factors for the development of muscle dissatisfaction and engagement in muscle-building behaviors have been described by theoretical frameworks and supported by empirical research. What remains unknown are the unique processes, including catalysts and facilitators, which underpin engagement in muscle-building behaviors. Therefore, this study used a grounded theory methodology to elucidate the process of engagement in muscle-building behaviors. Thirty-three individual semi-structured interviews with Canadian adolescents and young adults ages 16-30 years were conducted. Transcripts were analyzed using initial and focused coding to identify themes that explained the grounded theory. The core theme underpinning the grounded theory was balancing aesthetic, health, and functional goals in relation to participants' engagement in muscle-building behaviors. Participants described experiences that encompassed several unique phases of muscle-building engagement, including the initiation phase, beginner phase, preservation phase, and intensification phase. Participants also described unique methods of gathering information on muscle-building behaviors, and their own analysis and decision-making processes driving their behaviors. Findings from this study extend prior theory and research by conceptualizing a novel process theory of engagement in muscle-building behaviors among adolescent and young adults, resulting in important implications for research and practice.

How Parental Feeding Practices Relate to Young People's Intuitive Eating: Cross-Sectional and Longitudinal Associations by Gender and Weight Concern.

PURPOSE: To evaluate cross-sectional and longitudinal associations between controlling parental feeding practices in adolescence (i.e., restrictive feeding and pressure-to-eat [PE]) and intuitive eating (IE) in adolescence and emerging adulthood; and explore child gender and parental concern about child weight as moderators. METHODS: The sample included participants (N = 1,383) from the population-based EAT 2010-2018 study who provided data in adolescence (14.4 ± 2.0 years) and emerging adulthood (22.0 ± 2.0 years) and had at least one caregiver complete surveys in adolescence. Generalized estimating equations evaluated cross-sectional and longitudinal associations between restrictive feeding and PE in adolescence and IE in adolescence and emerging adulthood. Interactions with gender and parental concern over child weight in adolescence were explored. RESULTS: Restrictive feeding was cross-sectionally associated with lower IE in adolescence (b = -0.04), though evidence of moderation by parental weight concern indicated this association was only observed in the context of low parental weight concern. Greater PE was associated with lower adolescent IE among boys but higher IE among girls. Longitudinally, the association between PE in adolescence and IE in emerging adulthood differed by parental weight concern; greater PE predicted higher emerging adult IE at high parental weight concern, but lower IE at low parental weight concern. DISCUSSION: Controlling feeding practices in adolescence displayed differential associations with child IE in adolescence and emerging adulthood based on child gender and parental concern over child weight. Notably, PE was associated with greater IE among adolescent girls but lower IE among boys. Results suggest that parental feeding is a valuable intervention target.

The effects of brief diet and anti-diet social media videos on body image and eating concerns among young women.

The effects of photo-based platforms on body image concerns are well documented, yet it is unknown whether these effects replicate across video-based platforms such as TikTok. Thus, this experimental study aimed to examine the relationship between video-based platform use and body image. Women aged 18 to 21 (n = 421) were randomly assigned to watch two brief, consecutive TikTok videos in one of three conditions: (1) diet culture, (2) anti-diet, (3) neutral. Participants allocated to the anti-diet condition reported greater increases in weight and shape satisfaction as compared to the diet culture condition, and greater increases in state body appreciation and state intuitive eating as compared to the neutral condition. In addition, those allocated to the diet culture condition reported greater increases in restriction and urges to exercise, and smaller gains in positive mood, as compared to those in the neutral condition. Social media related rumination and thin-ideal internalization potentiated these effects.