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.

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.

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.

Parents and caregivers as key players in the prevention and identification of body image concerns and eating disorders among early adolescents.

Early adolescence (ages 11-14 years) is a key period for the emergence of body image and eating concerns, and early identification and access to treatment are imperative for positive outcomes. Despite research identifying this critical developmental period, few prevention resources are available for early adolescents. Parents are key players for this age group and important socializing agents. As such, they are well positioned to help youth access resources or support where needed. However, programs to position and involve parents as interventionists are lacking. Our aims are two-fold. First, we review the evidence for the effectiveness of parents as body image interventionists and the existing data regarding parental needs. Second, we provide directions for future research and outline a framework for empowering parents as interventionists, identifying key domains in which parents may play a role in addressing body image and eating concerns among early adolescents. Based on the extent literature, these domains include facilitating engagement with or co-utilizing intervention content to decrease body image and eating concerns in at-risk children, which may also help to increase parents' effectiveness in their efforts to support youth. In addition, parents may deliver content to decrease or reverse risk-factors and early symptoms, or disrupt the early disorder phase of illness. To date, parents constitute an underutilized resource in eating disorder and disordered eating prevention, and efforts should be made to increase the evidence-based strategies to leverage their relationship with at-risk children.

#Thisis40: Body image among adult women who post selfies.

Prior research suggests that using photo-based social media may increase body image concerns among young women. Consumption of versus contribution to social media may moderate this relationship, and the type of content contributed (e.g., self-images or "selfies") may further account for variations. A critical limitation of the extant scholarship is a lack of attention to understudied groups, such as older women. Using a cross-sectional sample of 238 midlife women (Mage = 50.92), this study investigated the relationship between social media behavior, perceived effects of social media use, and body image indices. Results indicated that our sample of midlife women contributed mainly photos of their current setting and family, contrasting with prior work among younger women. Results suggested that the type of content contributed may be more pertinent to body image than social media behavior generally, and highlighted complex relationships. Posting photos broadly was associated only with lower drive for youthfulness. However, selfie posting specifically was associated with greater facial satisfaction as well as greater positive (e.g., connectedness) and negative (e.g., appearance concerns) perceived effects of social media, but not drive for youthfulness. Results suggest that the type of content contributed to social media may be a particularly important factor for body image, and highlight complex relationships potentially influenced by unmeasured factors such as social media use motivations. Together, these findings contribute to a fuller understanding of social media and body image and call for further theoretically-driven work in this area to guide effective prevention resources.

Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity.

BACKGROUND: Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS: A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS: Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS: Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.

Cognitive rigidity and restrictive eating disorders: Delineating the impact of low weight, low fat, weight suppression, acute negative energy balance, and chronic restriction.

Restrictive eating disorders such as anorexia nervosa (AN) are characterized by extremely rigid cognitive and behavioral patterns, understood to underpin the chronic nature of these disorders. Interrogating the mechanisms contributing to and maintaining the rigid cognitive styles and limited behavioral repertoires, particularly in terms of restrictive eating and excessive exercise is of critical importance. Dietary restriction is overall understood to underpin this rigidity to a large extent, however, to date little is understood regarding the relative contributions of different aspects of restriction including low body weight, low fat mass, weight suppression, acute negative energy balance, and chronic restriction. Clarifying the respective roles of these different factors would be useful for both the better targeting intervention efforts in AN. Extending research to other disorders such as muscle dysmorphia, avoidant restrictive food intake disorders, or atypical AN, that may present similar features to AN but differ from it on other critical dimensions, may offer unique opportunities to identify clinical elements specific to these cognitive patterns. Doing so may inform interventions and pave the way towards more effective treatment approaches.

Examination of eating disorder psychopathology across sexual and gender identities among a Canadian sample.

OBJECTIVE: Eating disorders (EDs) disproportionately affect sexual and gender minorities, with majority of research conducted among samples in the United States. The purpose of this study was to examine ED psychopathology among adolescents and young adults in Canada with diverse gender and sexual identities. METHOD: Data were collected from 2,714 Canadians, aged 16-30 years old, via an online survey at the end of 2021 during the COVID-19 pandemic. Participants responded to sociodemographic questions (including history of EDs) and reported on eating attitudes and behaviors. Descriptive statistics and multiple modified Poisson and linear regressions were conducted. RESULTS: Over half the sample was heterosexual, 35% were sexual minority cisgender men and women, and 6.5% were transgender and gender non-conforming (TGNC) people. The sample overall reported elevated ED psychopathology based on their eating attitudes and behaviors. TGNC participants reported the most severe ED psychopathology. Generally, sexual minority cisgender women and cisgender men had elevated ED psychopathology compared to their heterosexual counterparts. Regression analyses revealed all gender and sexual minorities reported greater ED psychopathology compared to heterosexual cisgender men. DISCUSSION: The Canadian sample reported elevated ED psychopathology compared to previous studies among various populations. Additional investigations are now needed to observe how ED psychopathology continues to change after the onset of the pandemic. Further research is needed among cisgender men, TGNC people, and sexual minorities to understand the unique stressors they face that lead to high ED psychopathology, and develop appropriate prevention and treatment tools. PUBLIC SIGNIFICANCE: EDs affect people of all gender and sexual identities. People who identify as a gender and/or sexual minority often experience problematic eating attitudes and behaviors, particularly transgender and gender non-conforming people of all sexual identities. More research attention is needed among these populations, especially due to a paucity of research among Canadians, to develop effective diagnostic tools, prevention efforts, and treatment programs specific to gender and sexual identities.

The impact of climate change on eating disorders: An urgent call for research.

Climate change affects many of the documented risk factors for eating disorders (EDs) through direct and indirect pathways, yet to date the research in this area is nonexistent. Our aim is to identify the specific mechanisms through which climate change might be associated with increased risk for EDs, an exacerbation in symptoms, or poor clinical outcomes; highlight limited empirical data addressing these issues; and propose directions for a research program in this important area. Pathways for the impact of climate change on eating disorders and related data were reviewed. Four main pathways for the effects of climate change on EDs were identified including (1) decreased food access and security; (2) changes in mean temperature; (3) concerns related to food safety and eco-anxiety; and (4) indirect pathways through trauma, adversity, and increased mental health concerns. Except for the relationship between increased food insecurity and EDs, these pathways remain largely uninvestigated. Numerous factors may be implicated in the relationship between climate change and EDs. Future work in this area is imperative and should be conducted through a social justice lens with particular attention paid to the global areas most impacted by climate change and related vulnerabilities. Climate change will likely have adverse impacts on individuals with eating disorders and increase the risk for eating disorders. This paper reviews the different ways in which climate change may have these effects and calls for researchers to pay attention to this important area.

The relationship between individual symptom connectivity and global eating disorder symptom severity.

BACKGROUND: The network approach has emerged as a useful framework for conceptualizing and investigating psychopathology, including eating disorders. Network connectivity, that is, the density of the connections among network nodes, has been somewhat neglected despite its theoretical relevance. As predicted by network theory, symptom connectivity would be distinct but related to symptom severity and may be a useful clinical indicator of psychopathology as stronger and/or more diffuse connections among symptoms offer more avenues for symptom activation. This study aimed to investigate the relationship between moment-by-moment individual-level symptom connectivity and global levels of symptom severity in the context of eating disorder symptoms and experiences. METHODS: A sample of 58 female undergraduate college students, mean (SD) age = 20.5 (3.1) provided data on eating disorder symptoms eight times a day over the course of 10 days. Network analyses were used to calculate the eating disorder symptoms network connectivity for each participant. In addition, participants completed survey of self-report measures of eating disorder symptom severity and trait mindfulness and body image flexibility. RESULTS: Analyses revealed a moderate, positive relationship between individual network connectivity and eating disorder symptom severity. In addition, symptom connectivity predicted unique variance of symptom severity even after controlling for other clinically-relevant variables. CONCLUSIONS: Individual-level network connectivity may be an important dimension of psychopathology and further work exploring the role of network connectivity is warranted. PUBLIC SIGNIFICANCE: These findings suggest that symptom severity and the extent to which different eating disorder symptoms are connected are related but different dimensions. Investigating how these different dimensions play a role in eating disorder pathology could help to better understand and treat these disorders.

Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades.

OBJECTIVE: Sexual minority (SM) groups (e.g., those who identify as lesbian, gay, bisexual, questioning, queer, asexual, or those who feel their sexual orientation identity cannot be captured with existing terminology [LGBQA+] and those who report same-sex or same-gender attraction and/or behavior) are at elevated risk for eating disorder (ED) symptoms and behaviors. However, the ways in which this risk varies across SM is less clear, and findings are not fully convergent. Evolution in the definition and assessment of SM status may contribute to this divergence. The aim of this study was to systematically review how sexual orientation and SM status have been assessed in the ED literature and how this may relate to patterns of associations between SM status and ED symptoms. METHODS: A systematic review of the literature focused on ED symptoms and behaviors and SM groups was conducted, yielding 182 studies. RESULTS: Five categories were created reflecting SM status assessment: identity only (n = 105), attraction only (n = 8), behavior only (n = 4), combinations of identity, behavior, or attraction (n = 58), and articles with unclear or insufficient information about SM status assessment (n = 7). SM status operationalizations varied across studies, with more inclusive assessments in more recent work. Findings revealed persistent conflicting patterns of disordered eating symptomatology for some SM groups. In addition, decisions to selectively combine SM participants in some studies, most often to increase power, decreased the specificity of their results in relation to differential risk and protective factors within specific LGBQA+ groups. DISCUSSION: Findings highlight the importance of inclusive assessments of sexual orientation in the ED literature and research focused on underrepresented groups with intersecting identities. Identifying modifiable targets for intervention is a critical next step. PUBLIC SIGNIFICANCE: Sexual minority (SM) groups have been identified as presenting elevated risk for eating disorder symptoms and behaviors. Our findings suggest that the level of risk is variable across SM groups and points to the need for multi-dimensional assessments of SM status, and increased focus on the function of disordered eating behaviors and different profiles that might emerge related to efforts to modify physical appearance or to regulate emotion.

OBJETIVO: Los grupos de minorías sexuales (SM) tienen un riesgo elevado de síntomas y comportamientos de trastornos de la conducta alimentaria. Sin embargo, las formas en que este riesgo varía entre SM son menos claras. La evolución en la definición y evaluación del estatus de SM puede contribuir a esta divergencia. El objetivo de este estudio fue revisar sistemáticamente cómo se han evaluado la orientación sexual y el estado de SM en la literatura sobre trastornos de la conducta alimentaria y cómo esto puede relacionarse con los patrones de asociaciones entre el estado de SM y los síntomas del trastorno alimentario. MÉTODOS: Se realizó una revisión sistemática de la literatura centrada en los síntomas y comportamientos del trastorno de la conducta alimentaria y los grupos de SM, que arrojó 182 estudios. RESULTADOS: Se crearon cinco categorías que reflejan la evaluación del estado de SM: solo identidad (n = 105), solo atracción (n = 8), solo comportamiento (n = 4), combinaciones de identidad, comportamiento o atracción (n = 58) y artículos con información poco clara o insuficiente sobre la evaluación del estado de SM (n = 7). Las operacionalizaciones del estado de SM variaron entre los estudios, con evaluaciones combinadas más inclusivas en el trabajo más reciente. Los hallazgos revelaron patrones persistentes y conflictivos de sintomatología alimentaria disfuncional para algunos grupos de SM. Además, las decisiones de combinar selectivamente a los participantes de SM en algunos estudios, con mayor frecuencia para aumentar el poder, disminuyeron la especificidad de sus resultados en relación con el riesgo diferencial y los factores de protección dentro de grupos LGBQA+ específicos. DISCUSIÓN: Los hallazgos resaltan la importancia de las evaluaciones inclusivas de la orientación sexual en la literatura sobre trastornos alimentarios y la investigación centrada en grupos subrepresentados con identidades que se cruzan. Identificar objetivos modificables para la intervención como recursos es un siguiente paso crítico.

Maternal mood, body image, and eating habits predict changes in feeding practices during the COVID-19 pandemic.

Maternal mood and eating habits are associated with food parenting practices, including non-responsive feeding practices, which in turn impact children's eating habits. The COVID-19 pandemic may have negatively impacted maternal mood due to the overall stress and challenges, contributing to changes in eating behaviors and food parenting practices. The present study examined how maternal mood, body image, and eating concerns were related to perceived changes in feeding practices during the pandemic. A total of 137 mothers participated in an online study. Participants retrospectively reported their mood, eating habits, body dissatisfaction, and non-responsive feeding practices, before and during the pandemic, and responded to open-ended questions regarding changes in eating and feeding patterns during the pandemic. Results suggested differences in non-responsive feeding practices, including higher use of food as a reward for behavior and lower use of standard meal settings during the pandemic. In addition, significant relationships were found between higher maternal stress and higher body dissatisfaction (r = 0.37; p < .01), restrained eating (r = 31; p < .01), emotional eating (r = 0.44; p < .01), and higher use of overt and covert restriction retrospectively and during the pandemic. Results revealed trends in the same direction for depression and anxiety. Finally, qualitative findings were consistent with the quantitative findings, suggesting relationships between maternal mood, eating habits, and feeding practices. These results provide support for previous findings suggesting that the pandemic negatively impacted maternal well-being, increasing the use of some non-responsive feeding practices. Further work exploring the impacts of the pandemic on well-being, child feeding, and eating patterns is warranted.

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.

Contemporary screen use and symptoms of muscle dysmorphia among a national sample of Canadian adolescents and young adults.

PURPOSE: Screen time has been previously linked to body dissatisfaction and eating disorder behaviors. However, less is known about whether use of common forms of screen technology is associated with symptoms of muscle dysmorphia (MD), which was the aim of this study. METHODS: Data from the Canadian Study of Adolescent Health Behaviors (N = 2538) were analyzed. Associations between hours of use of six contemporary forms of recreational screen time, as well as total screen time, and symptoms of MD were determined using multiple linear regression models, stratified by gender, and adjusting for potential confounders. RESULTS: Among both men and women, greater total screen time and texting were associated with greater symptoms of MD; however, differences emerged across the screen time modalities by gender. Among women, video chatting was most strongly associated with symptoms of MD, while social media use was most strongly associated with symptoms of MD among men. CONCLUSION: Findings add to the growing literature documenting the potentially harmful correlates of screen time by including MD symptomatology. Findings have important implications for health care, public health, and policymaking professionals. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Body image concerns and disordered eating among older women: Identifying variables of interest for integrated models.

OBJECTIVE: Research focused on developing risk and protective models of body image concerns and disordered eating among older women is scant. Models including biological, psychological, and sociocultural elements may be useful explanatory frameworks in this group. Thus, the aim of this study was to conduct formative research exploring the constructs that form part of biopsychosocial models of body image concerns and disordered eating among older women. METHOD: A sample of 184 women aged 60-75 years completed an online survey assessing media pressures, thin-ideal internalization, depression symptoms, weight and shape concerns, and disordered eating as well as positive reappraisal and acceptance of aging-related changes to appearance. RESULTS: After the addition of two supplemental pathways, the model revealed good fit to the data. In the final model, age, depression, and media pressure were associated with media internalization, that was in turn associated with weight and shape concerns, and then disordered eating. Depression was also directly associated with both weight and shape concerns and disordered eating. The model varied across older women with high versus low levels of positive reappraisal and acceptance of aging-related changes to appearance. Specifically, among those high on this trait, the pathways between depression and thin-ideal internalization, and between weight and shape concerns and disordered eating were significantly weaker. DISCUSSION: These findings support the usefulness of biopsychosocial models for grounding research on body image concerns and disordered eating among older women, and suggest positive reappraisal and acceptance of aging-related changes to appearance as a useful dimension to focus on.

Fear of fatness and desire for thinness as distinct experiences: A qualitative exploration.

OBJECTIVE: The pursuit of thinness and fear of gaining weight have been found to play an important role in eating disorder symptomatology. While these dimensions have typically been considered conjointly, emerging evidence suggests they may be distinct dimensions. The aim of this study was to explore the subjective experiences of fear of fatness and drive for thinness in young women with body image concerns. METHOD: Young women endorsing weight concerns (N = 29, mean age = 20.86, SD = 2.70 years) were interviewed and asked to describe an experience of fear of fat and drive for thinness, respectively. RESULTS: Qualitative analysis was conducted and identified four themes: (1) precipitating events; (2) physiological, emotional, cognitive, and proprioceptive experiences; (3) coping strategies; and (4) sociocultural influences. While similarities emerged, the experiences of fear of fatness, and of drive for thinness also evidenced clear differences situating the former in the context of fear-based avoidance patterns, and the latter in approach-based reward models. DISCUSSION: These findings provide additional support for the usefulness of considering fear of fat and drive for thinness as distinct constructs. Further research examining the contributions of each of these constructs to eating pathology is warranted.

Digging up the dirt on "clean" dietary labels: Public health considerations and opportunities for increased Federal oversight.

BACKGROUND: "Clean" dietary labels are often viewed by consumers as referencing products that are minimally processed, without additives, preservatives, artificial colors, or ingredients, but may also be interpreted as vegan, gluten-free, dairy-free, "real," or "natural." Although the "clean" diet trend continues to grow in popularity, there is a lack of consensus regarding the definition and use of this terminology with a corresponding lack of regulation for such labels in the United States. METHOD: This multidisciplinary scoping review examines the public health implications of the "clean" label trend and the legal and policy landscape for regulation. We report on findings from case law and legal research generated through the Westlaw database and from the U.S. Food and Drug Administration (FDA) enforcement actions and website documents to discuss options for federal- and state-level intervention to mitigate harm. RESULTS: One feasible avenue for change is for the FDA to provide industry guidance, disseminate public statements to debunk myths, and enforce labeling statutes to police deceptive "clean" labeling claims. We also suggest consumer-protection litigation and state-level litigation via attorneys general as alternative actions to combat the abundant misinformation associated with "clean" diets and labels. DISCUSSION: Although the FDA has taken some enforcement actions, these efforts are insufficient given the proliferation of "clean" label products in the marketplace and the potential for adverse impacts on public health including increased risk for disordered eating. The current unregulated, undefined landscape for "clean" dietary labels thus requires urgent action by federal authorities and state attorneys general.

A systematic scoping review of research on COVID-19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field.

OBJECTIVE: Research investigating the effects of COVID-19 on eating disorders is growing rapidly. A comprehensive evaluation of this literature is needed to identify key findings and evidence gaps to better inform policy decisions related to the management of eating disorders during and after this crisis. We conducted a systematic scoping review synthesizing and appraising this literature. METHOD: Empirical research on COVID-19 impacts on eating disorder severity, prevalence, and demand for treatment was searched. No sample restrictions were applied. Findings (n = 70 studies) were synthesized across six themes: (a) suspected eating disorder cases during COVID-19; (b) perceived pandemic impacts on symptoms; (c) symptom severity pre versus during the pandemic; (d) pandemic-related correlates of symptom severity; (e) impacts on carers/parents; and (f) treatment experiences during COVID-19. RESULTS: Pandemic impacts on rates of probable eating disorders, symptom deterioration, and general mental health varied substantially. Symptom escalation and mental health worsening during-and due to-the pandemic were commonly reported, and those most susceptible included confirmed eating disorder cases, at-risk populations (young women, athletes, parent/carers), and individuals highly anxious or fearful of COVID-19. Evidence emerged for increased demand for specialist eating disorder services during the pandemic. The forced transition to online treatment was challenging for many, yet telehealth alternatives seemed feasible and effective. DISCUSSION: Evidence for COVID-19 effects is mostly limited to participant self-report or retrospective recall, cross-sectional and descriptive studies, and samples of convenience. Several novel pathways for future research that aim to better understand, monitor, and support those negatively affected by the pandemic are formulated.

OBJETIVO: La investigación que se hace sobre los efectos de COVID-19 en los trastornos de la conducta alimentaria está creciendo rápidamente. Se necesita una evaluación exhaustiva de esta literatura para identificar los hallazgos clave y evidenciar las brechas para informar mejor las decisiones de políticas públicas relacionadas con el manejo de los trastornos de la conducta alimentaria durante y después de esta crisis. Se realizó una revisión sistemática del alcance que sintetizó y valoró esta literatura. MÉTODO: Se buscó investigación empírica sobre los impactos de COVID-19 en la gravedad, prevalencia y demanda de tratamiento de los trastornos de la conducta alimentaria. No se aplicaron restricciones a la muestra. Los hallazgos (n = 70 estudios) se sintetizaron en seis temas: (1) casos sospechosos de trastornos de la conducta alimentaria durante COVID-19; (2) impacto percibido en los síntomas; (3) gravedad de los síntomas antes versus durante la pandemia; (4) correlatos relacionados con la pandemia de la gravedad de los síntomas; (5) impactos en los cuidadores/padres; (6) experiencias de tratamiento durante COVID-19. RESULTADOS: El impacto de la pandemia en las tasas de probables trastornos de la conducta alimentaria, deterioro de los síntomas y salud mental en general variaron sustancialmente. La escala de síntomas y el empeoramiento de la salud mental durante y debido a la pandemia fueron reportados comúnmente, y los más susceptibles incluyeron casos confirmados de trastornos de la conducta alimentaria, poblaciones en riesgo (mujeres jóvenes, atletas, padres / cuidadores) e individuos con altos niveles de ansiedad o con miedo de COVID-19. Surgió alguna evidencia de una mayor demanda de servicios especializados en trastornos de la conducta alimentaria durante la pandemia. La transición forzada al tratamiento en línea fue un desafío para muchos, sin embargo, las alternativas de telesalud parecían factibles y efectivas. Conclusiones. La evidencia de los efectos de COVID-19 se limita principalmente al autoinforme de los participantes o al recuerdo retrospectivo, los estudios transversales y descriptivos, y las muestras de conveniencia. Se formulan varias vías novedosas para futuras investigaciones que tienen como objetivo comprender, monitorear y apoyar mejor a aquellos que fueron afectados negativamente por la pandemia.

Weight gain attempts and diet modification efforts among adults in five countries: a cross-sectional study.

BACKGROUND: Recent research has emphasized a growing trend of weight gain attempts, particularly among adolescents and boys and young men. Little research has investigated these efforts among adults, as well as the specific diet modifications individuals who are trying to gain weight engage in. Therefore, the aims of this study were to characterize the diet modification efforts used by adults across five countries who reported engaging in weight gain attempts and to determine the associations between weight gain attempts and concerted diet modification efforts. METHODS: Cross-sectional data from the 2018 and 2019 International Food Policy Study, including participants from Australia, Canada, Mexico, the United Kingdom, and the United States (N = 42,108), were analyzed. In reference to the past 12 months, participants reported on weight gain attempts and diet modification efforts related to increased consumption of calories, protein, fiber, fruits and vegetables, whole grains, dairy products, all meats, red meat only, fats, sugar/added sugar, salt/sodium, and processed foods. Unadjusted (chi-square tests) and adjusted (modified Poisson regressions) analyses were conducted to examine associations between weight gain attempts and diet modification efforts. RESULTS: Weight gain attempts were significantly associated with higher likelihood of each of the 12 forms of diet modification efforts among male participants, and 10 of the diet modification efforts among female participants. Notably, this included higher likelihood of efforts to consume more calories (males: adjusted prevalence ratio [aPR] 3.25, 95% confidence interval [CI] 2.94-3.59; females: aPR 4.05, 95% CI 3.50-4.70) and fats (males: aPR 2.71, 95% CI 2.42-3.03; females: aPR 3.03, 95% CI 2.58-3.55). CONCLUSIONS: Overall, the patterns of association between weight gain attempts and diet modification efforts may be indicative of the phenomenon of muscularity-oriented eating behaviors. Findings further highlight the types of foods and nutrients adults from five countries may try to consume in attempts to gain weight.

Associations between muscle-building exercise and alcohol use behaviors among adolescent boys: Results from the 2019 Youth Risk Behavior Survey.

BACKGROUND AND OBJECTIVES: To explore the association between muscle-building exercise (MBE) and alcohol use behaviors among adolescent boys. METHODS: Data from the 2019 Youth Risk Behavior Survey (N = 4120) were analyzed using multiple logistic regressions. RESULTS: A greater number of days of MBE in the past week was associated with higher odds of four alcohol use behaviors, including recent alcohol use and binge drinking. DISCUSSION AND CONCLUSIONS: Findings extend prior research showing relationships between team sports participation and alcohol use behaviors. SCIENTIFIC SIGNIFICANCE: This study is the first to examine associations between MBE and alcohol use behaviors among adolescent boys.