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.

Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review.

Objective: Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. Methods: PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters. Results: A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. Conclusions: This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.

Lay beliefs about the perceived harmfulness of excess weight: Influence of weight status and the cause of weight.

Health campaigns often emphasise the association between excess weight and poor health. Past research suggests that whether an individual's excess weight is viewed as harmful is partially explained by the quantity of excess weight. The present research explored whether the purported cause of excess weight also influences its perceived harmfulness. Across two studies (total N = 577), participants read information about target individuals whose excess weight was caused by different factors (unhealthy lifestyle vs. medical condition). Participants rated the extent to which the target's weight was harmful and also recommended health-related behaviours to the target. For the target with overweight, when her weight was described as being caused by unhealthy behaviours as opposed to a medical condition, her weight was rated as more harmful, and she was recommended to engage in more healthy behaviours. For the target with obesity, her weight was viewed as harmful irrespective of its described cause. Compared with the target with overweight, the weight of the target with obesity was rated as more harmful and she was recommended to diet more. Perceptions of the harmfulness of 'overweight' are influenced by the purported cause of that overweight, whereas obesity itself is viewed as harmful, regardless of the cause.

Compensatory eating after exercise in everyday life: Insights from daily diary studies.

There is considerable variability in how successful people are in losing weight via exercise programs. Experimental research suggests that greater food intake after exercise may be one factor underlying this variability, but no studies have assessed patterns of post-exercise eating behaviour over time in naturalistic settings. Thus, we aimed to assess how exercise and contextual factors (e.g., hunger, presence of others) influence the healthiness and amount of food eaten after exercise in two daily diary studies. In Study 1, participants (n = 48) reported their food intake and exercise daily for 28 days. For each meal, they provided a brief description of the food(s) eaten which were then categorised as healthy, unhealthy, or mixed (neither healthy nor unhealthy) by two independent coders. Study 2 used the same method, but participants (n = 55) also reported the portion size of each meal. Hierarchical linear modelling showed that in Study 1, contrary to expectations, post-exercise meals were less likely to be unhealthy (relative to mixed) than were random meals from non-exercise days (OR = 0.63, p = .011), and that participants ate proportionally fewer unhealthy meals on exercise days compared to non-exercise days (b = -4.27, p = .004). Study 2 replicated these findings, and also found that participants consumed larger meals after exercise in comparison to random meals from non-exercise days (b = 0.25, p < .001). Participants were not consistently engaging in compensatory eating by eating less healthily after exercise compared to on non-exercise days, but they did eat larger portions post-exercise. This work highlights the need for naturalistic methods of assessing compensatory eating, and has the potential to facilitate development of strategies to improve health behaviour regulation.

Testing the Identity Disruption Model among Adolescents: Pathways Connecting Adverse Childhood Experiences to Body Dissatisfaction.

The Identity Disruption Model posits that early adversity is associated with lower self-concept clarity, which in turn increases vulnerability to sociocultural appearance factors and body dissatisfaction, but this model has not previously been tested among adolescents. Testing the model during adolescence is critical because this is a key point of development of both identity and body dissatisfaction. This paper presents two studies with adolescents recruited through social media (Study 1: n = 213; 78% female; mean age = 15.7 years, SD = 1.14) and from high schools (Study 2; n = 228; 43% female; mean age = 13.8 years, SD = 1.15). In both studies, self-reported early adversity was associated with lower self-concept clarity; lower self-concept clarity was associated with greater internalization of appearance ideals and more frequent appearance comparisons; and internalization and appearance comparisons were associated with greater body dissatisfaction. This research builds on previous sociocultural models of body dissatisfaction by pointing to processes that occur early in life that could be potential targets of intervention and prevention efforts.

Body dissatisfaction frequency and duration: Dissociable dimensions of trait body dissatisfaction.

This work proposes that trait body dissatisfaction rests on two dissociable components: 1) frequency of body dissatisfaction episodes, and 2) duration of such episodes, with higher trait body dissatisfaction resulting from more frequent and/or prolonged episodes. The current research aimed to develop a measure of these two dimensions (i.e., the Body Dissatisfaction Frequency Duration Questionnaire; BDFDQ) and test this theoretical model by investigating whether body dissatisfaction frequency and duration 1) were structurally dissociable, 2) meaningfully dissociable, and 3) each associated with different aspects of disordered eating behavior. Study 1 (N = 300, 42% women) developed the BDFDQ and showed that frequency and duration are structurally dissociable. Study 2 (N = 400, 50% women) showed that the two-factor model was invariant across gender and both subscales showed good psychometric properties of reliability and validity. Results further supported that frequency and duration are meaningfully dissociable by revealing that each component accounted for unique variance in trait body dissatisfaction. Study 3 (N = 279, 77% women) replicated Study 2 findings and established that frequency and duration subscales each associated with different aspects of disordered eating behavior. Together, findings imply that body dissatisfaction frequency and duration represent two separable dimensions underlying trait body dissatisfaction.

Social facilitation of energy intake in adult women is sustained over three days in a crossover laboratory experiment and is not compensated for under free-living conditions.

People eat more when they eat a meal with familiar others than they do when eating alone. However, it is unknown whether eating socially impacts intake over the longer-term. The aim of Study 1 was to examine whether socially facilitated intake is sustained across all meals and across three consecutive days. The aim of Study 2 was to examine whether increased intake during a social meal taken in the laboratory is compensated for under free-living conditions. In Study 1, adult women (n = 26) ate all their meals across three days either with a friend or alone in a counterbalanced cross-over design. In Study 2 adult women (n = 63) consumed a meal in the laboratory either alone or with two friends and then recorded everything they ate and drank for the next three days using electronic food diary software. In Study 1 intake across 3 days was significantly greater in the Social (M = 7310 kcal, SD = 1114) than in the Alone condition (M = 6770 kcal, SD = 974) (F(1,423) = 16.10, p < .001, d = 0.51). In Study 2 participants consumed significantly more in the laboratory when eating with their friends (M = 1209 kcal, SD = 340) than when eating alone (M = 962 kcal, SD = 301) (F(1,63) = 13.28, p = .001, d = 0.77). Analysis of food diary data plus laboratory intake showed that intake remained significantly greater in the Social (M = 6396 kcal, SD = 1470) than in the Alone condition after 4 days (M = 5776 kcal, SD = 1182) (F(1,59) = 5.59, p = .021, d = 0.05). These results show that social facilitation of eating is sustained over three days and suggest that people fail to compensate for the social facilitation of eating.

Influence of social-normative information on the modeling of food-related decisions.

Social modeling is a powerful influence on people's food intake: When there is a clear and consistent norm, people eat more when eating with someone who eats a lot and eat less when eating with someone who eats only a little. In three studies, the present research examined how clear versus ambiguous social-normative information influences the modeling of food-related decisions. Using a novel online decision-making paradigm, female participants (total N = 1042) were provided with information about how many cookies previous participants had supposedly selected (no information was provided in the control condition), and then decided how many cookies they would choose for a snack. When there was a clear and consistent norm, the typical social modeling effect was observed. When there was a small number of "dissenters" whose responses conflicted with the norm set by the majority, participants' cookie selection still conformed to the behaviour of the majority (Studies 1 and 2). It was only when the behaviour of the previous participants was highly ambiguous that participants behaved as if they had been given no normative information (Study 3). By demonstrating that, except in extreme cases, people use the available information to discern a social norm that influences their behaviour, these findings highlight the power of social norms related to food-related decisions.

People's intended serving behaviour at social vs. non-social meals.

The social facilitation of eating refers to people's tendency to eat more food when dining with others than when dining alone. Recent research suggests that social facilitation may be driven by people's tendency to make more food available even before social meals begin, a phenomenon referred to as social "precilitation." In order to uncover the mechanisms underlying social precilitation, it is helpful to first understand whether people consciously and deliberately make more food available for social meals. Three studies (total N = 792) used an online serving paradigm to investigate this question. Participants were asked to imagine dining alone and dining socially, and indicated how much food they would serve themselves in each scenario. Unexpectedly, participants consistently reported intending to serve themselves smaller portions for social meals than for non-social meals (Study 1). This effect emerged even when they were asked about how someone else would behave (Study 2), and when they were informed that there was plenty of food available at the social meal (Study 3). This research highlights a disconnect between people's intended serving behaviour and the actual serving behaviour observed in laboratory studies, and suggests that people may not be aware of how their behaviour is influenced by the social context. Future research should examine why the disconnect between people's intended and actual serving behaviour occurs, whether it is related to the amount of food provided for social meals, and what implications the disconnect has for people's ability to manage their food intake.

Self-concept clarity and appearance-based social comparison to idealized bodies.

Exposure to images of idealized bodies in the media has been shown to increase body dissatisfaction among women. One of the mechanisms through which exposure influences body dissatisfaction is appearance-based comparison with the people in the images. The present study tested the hypothesis that individuals low in self-concept clarity (i.e., individuals who lack a clear sense of their own identity) would be more likely to compare themselves to images of thin models, and would consequently experience greater body dissatisfaction. White female participants (N = 489) were exposed to either images featuring idealized bodies or neutral control images, and then indicated the extent to which they compared their appearance to that of the targets and reported their level of body dissatisfaction. A moderated-mediation model showed that the effect of exposure condition on body dissatisfaction via appearance comparison to the targets depended on the participant's level of self-concept clarity. Those with lower self-concept clarity engaged in greater comparison when exposed to idealized images relative to control images, leading to greater post-exposure body dissatisfaction. These findings suggest that low self-concept clarity might increase vulnerability to the negative effects of exposure to idealized media images.

The psychological effects of blind and open weighing in women with a high drive for thinness: A mixed method inquiry.

Regular weighing is a routine component of public health interventions but concerns have been raised about possible negative psychological consequences. Blind weighing is an alternative form of weighing that is commonly used in clinical contexts, and that is thought to decrease weighing anxiety and engagement with disordered eating behaviours. In this study, normal weight female participants who indicated a high drive for thinness (N = 53) were randomly assigned to receive bi-weekly open or blind weighing for three weeks. Participants who were open weighed felt increasingly anxious over time, whereas participants who were blind weighed felt less anxious. Both groups experienced increased weight preoccupation and disordered eating behaviours on weighing days compared to non-weighing days. Analyses of participants' qualitative responses further indicated that open weighed participants experienced increased urges to engage in weight-controlling behaviours throughout the experiment whereas blind weighed participants reported reduced concern with weight. Findings suggest that blind weighing may be a safer approach to weight monitoring, even though weighing in both forms can have a (transient) negative effect. Future research should evaluate whether the current findings are generalisable for other subgroups of the population.

Targets of comparison and body image in women's everyday lives: The role of perceived attainability.

Appearance comparisons can negatively influence women's body image, but little is known about the potential impact of comparison targets. We conducted an ecological momentary assessment study in which female undergraduate students (N = 146) completed a brief online survey at five random times every day for five days. In this survey, participants were asked if they had made an appearance comparison. If so, they were asked who they compared themselves to (i.e., close peer, acquaintance, stranger, celebrity/model), how they rated compared to that person (i.e., more attractive, just as attractive, less attractive), and how attainable that person's appearance is to them. All participants then completed state measures of mood, appearance satisfaction, and intention to diet and exercise. Upward comparisons (i.e., to more attractive others) to all targets were associated with less appearance satisfaction, lower positive mood, and more thoughts of dieting and exercising than when no comparisons were made. There were indirect relationships between comparisons to celebrities/models versus all other targets and appearance satisfaction via perceived attainability of the target's appearance. These findings suggest that celebrities may be particularly harmful appearance comparison targets in women's everyday lives because their attractive appearance is perceived to be less personally attainable than other targets.

People serve themselves larger portions before a social meal.

One of the most powerful influences on food intake yet identified is the presence of familiar others at an eating occasion: people eat much more when they eat with friends/family than when they eat alone. But why this is the case is unclear. Across two studies (Study 1: N = 98; Study 2: N = 120), we found that the mere anticipation of social interaction is all that is needed to promote the selection of larger meals, and that this occurs even when a person is alone when they make their decision. Adult women served themselves larger portions when they knew they were going to eat socially versus when they knew they were going to eat alone. These data suggest that how other people influence our food intake reaches beyond the specific eating context to affect pre-meal portion size decisions, suggesting that a fundamental shift is required in our thinking about social influences on eating.

Investigating lay beliefs regarding the effect of weight loss on health.

OBJECTIVE: Individuals with obesity are often recommended weight loss for their health; however, the amount of weight loss that is recommended varies. Lay people's beliefs about weight loss could influence the types of behaviours they view as necessary for people with obesity. The present study explored lay beliefs regarding the health benefits of varying degrees of weight loss. DESIGN: Participants (379 community members and 235 students) read information about an obese target who lost varying amounts of weight (none vs. modest vs. substantial) following behaviour changes. MAIN OUTCOME: Participants evaluated the target's health and recommended health-related behaviours to the target. RESULTS: The substantial weight-loss target, but not the modest weight-loss target, was perceived as being healthier than the no weight-loss target. There were no differences in behaviour recommendations made to the no weight-loss and modest weight-loss targets, with most participants recommending further weight loss to both targets. CONCLUSIONS: Lay people appear to view substantial, but not modest, weight loss as beneficial to health, and they recommend further, more unrealistic amounts of weight loss to obese individuals who have already achieved modest weight loss. A failure to recognise the health benefits of modest weight loss may contribute to unrealistic weight loss goals.

Patient perspectives on psychological care after bariatric surgery: A qualitative study.

Psychological interventions may be effective in improving adherence after bariatric surgery; however, there is limited research on patients' willingness to engage with psychological aftercare. This study aimed to qualitatively explore patient perspectives on psychological services in the bariatric setting. Participants reported believing that psychological care is essential for treatment success and indicated that they wanted support with adjusting to changes in lifestyle, self-identity, and relationships after surgery. Participants suggested that psychological aftercare should be recommended by their medical team and incorporated into standard management after bariatric surgery. These findings can be used to inform the design of services for bariatric surgery patients.

Modeling of food intake among restrained and unrestrained eaters.

The Theory of Normal Eating suggests that how much others eat sets an upper limit for how much it is appropriate to eat. This study tested the hypothesis that restrained eaters, who typically eat less than they want to, would be more responsive to a high-intake norm than would unrestrained eaters. Data were combined from 8 experimental studies (total N = 735 female participants; 305 restrained eaters, 430 unrestrained eaters). Each study: (a) included a low-intake norm, a high-intake norm, and a no-norm control condition; (b) measured participants' food intake; and (c) included the Restraint Scale as a measure of dietary restraint. There were no differences between restrained unrestrained eaters in the no-norm control condition or in the magnitude of the inhibition effect (i.e., the difference between the low-intake norm condition and the control condition). There was, however, a restraint difference in the magnitude of the augmentation effect (i.e., the difference between the high-intake norm condition and the control condition). Restrained eaters showed a larger augmentation effect (d = 0.58; 95% CI = 0.29, 0.87) than did unrestrained eaters (d = 0.20; 95% CI = -0.05, 0.45). Social norms provide an upper limit for acceptable food intake, with high-intake norms permitting (but not requiring) individuals to indulge themselves. The fact that restrained eaters were more responsive to the high-intake norm than were unrestrained eaters suggests that the high-intake norm gives restrained eaters permission to indulge when they typically eat less than they want to.

Blind versus open weighing from an eating disorder patient perspective.

BACKGROUND: Weighing is a key component in the treatment of eating disorders. Most treatment protocols advocate for open weighing, however, many clinicians choose to use blind weighing, especially during the early phase of treatment. Despite considerable debate about this issue in the literature, there is no empirical evidence supporting the superiority of one weighing approach over the other. In addition, little is known about patients' perspectives of open and blind weighing and which weighing practice they view as more acceptable and/or beneficial for their treatment. METHODS: Semi-structured qualitative interviews were conducted with 41 women with a current or past diagnosis of Anorexia or Bulimia Nervosa: 26 were undergoing specialist inpatient treatment (n = 13 being blind weighed; n = 13 being open weighed) and 15 were community members who have recovered from an eating disorder. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics, weighing anxiety and weight concerns were also assessed. RESULTS: Qualitative analyses yielded five themes: (1) therapy engagement and progress; (2) Control and tolerance of weight uncertainty; (3) treatment team relationships and autonomy; (4) life outside of treatment; and (5) weighing practice preferences and rationale. Participants stated that blind weighing decreased anxiety and eating disorder psychopathology (e.g., weight preoccupation) and increased treatment responsivity. For many, relinquishing control over their weight facilitated body trust and was a necessary step towards recovery. Participants found that not knowing their exact weight helped challenge their overconcern with weight. Lack of support post-discharge was identified as a major difficulty of blind weighing. Overall, the majority of participants preferred blind weighing, particularly at the early, acute stage of treatment, whereas open weighing was viewed as more suitable at later stages of recovery. Quantitative analyses found current blind-weighed patients felt significantly less anxiety around being weighed and had greater tolerance of weight uncertainty than current open-weighed patients. CONCLUSIONS: This study provided in-depth patient insights into open versus blind weighing practices. The next step for future research will be to supplement these insights with treatment outcomes gained from randomised controlled trials comparing the two weighing practices.

Efficacy and acceptability of a pilot dietary intervention focusing on self-compassion, goal-setting and self-monitoring.

OBJECTIVE: Overweight and obesity are universal health challenges. Recent evidence emphasises the potential benefits of addressing psychological factors associated with obesity in dietary programmes. This pilot study investigated the efficacy and acceptability of a combined online and face-to-face dietary intervention that used self-compassion, goal-setting and self-monitoring to improve dietary behaviour, as well as psychological factors associated with dietary behaviour. DESIGN: Embedded mixed methods including a 4-week before-after trial and a one-on-one interview. Quantitative outcomes of the study were the levels of self-compassion; eating pathology; depression, anxiety and stress; and dietary intake. Qualitative outcomes were participants' perceptions about the acceptability of the intervention. SETTING: UNSW Kensington campus. PARTICIPANTS: Fourteen participants with overweight and obesity aged between 18 and 55 years old. RESULTS: Results showed that the intervention significantly improved self-compassion and some aspects of dietary intake (e.g. decrease in energy intake) at Week Four compared with Week Zero. Some aspects of eating pathology also significantly decreased (e.g. Eating Concern). However, changes in self-compassion over the 4 weeks did not significantly predict Week Four study outcomes, except for level of stress. Most participants found self-compassion, goal-setting and self-monitoring to be essential for dietary behaviour change. However, participants also indicated that an online programme needed to be efficient, simple and interactive. CONCLUSIONS: In conclusion, the current study provides preliminary but promising findings of an effective and acceptable combined online and face-to-face intervention that used self-compassion, goal-setting and self-monitoring to improve dietary habits. However, the results need to be examined in future long-term randomised controlled trials.

What does it mean to overeat?

"Overeating" is a significant public health concern, but little is known about how lay people conceptualize overeating. This study explored participants' conceptions of overeating. Participants were 175 university students and 296 community members (56% women) who were asked to rate the extent to which several statements reflected the concept of "overeating" (1 = Does not capture the meaning at all; 7 = Captures the meaning perfectly). Results showed that eating outside of hunger was viewed as being most strongly linked to the conceptualization of overeating; mindless eating, eating more than some normative amount, and a lack of restriction were all moderately linked to the conceptualization of overeating; and the quality of the food/eating style was rated as least relevant to the conceptualization of overeating. Participants with a higher BMI, participants who perceived themselves as fat, restrained eaters, and participants with an indication of eating pathology rated all of the constructs as more relevant to the concept of overeating than did their respective counterparts, but their overall pattern of responding was the same. The present research provides some initial insights into people's thoughts on what it means to "overeat," which is important given that simply believing that one has overeaten (regardless of the actual amount consumed) can have adverse psychological and behavioral consequences. These insights provide an avenue for future research to explore whether lay conceptions could be more adaptively reshaped to reduce the negative effects of perceived overeating.

How might childhood adversity predict adult psychological distress? Applying the Identity Disruption Model to understanding depression and anxiety disorders.

BACKGROUND: Experiencing adversity in childhood is associated with increased risk of a range of psychopathologies, including depression and anxiety disorders. However, there is limited understanding of psychological mechanisms that may help to explain these relationships. The Identity Disruption Model proposes that early adversity can disrupt typical identity development, which may then increase one's vulnerability to psychopathology. The present study aims to apply the Identity Disruption Model to understanding symptoms of depression, generalized anxiety disorder, obsessive-compulsive disorder (OCD), and social anxiety. METHODS: A non-clinical sample of adults from the United States (n = 382) completed an online survey assessing early adversity, self-concept clarity, intolerance of uncertainty, and depression, generalized anxiety, OCD, and social anxiety symptoms. Structural equation models: (1) tested whether early adversity predicts psychopathology via a disrupted sense of self, and (2) explored the role of intolerance of uncertainty in the relationship between early adversity and psychopathology. RESULTS: Early adversity predicted more severe symptoms of depression and anxiety via lower self-concept clarity. Furthermore, a parallel mediation model showed that self-concept clarity and intolerance of uncertainty simultaneously mediated the relationship between early adversity and psychopathology. LIMITATIONS: The data are cross-sectional in nature and longitudinal research is needed to more conclusively test the causal pathways. CONCLUSIONS: Disrupted identity may be one mechanism through which childhood adversity predicts depression and anxiety disorder symptoms later in life. The Identity Disruption Model provides new avenues for future research and suggests potential points of early intervention for the prevention of depression and anxiety disorders.