A case for integrating self-compassion interventions targeting shame and self-criticism into eating disorder treatment: Commentary on Paranjothy and Wade.

Paranjothy and Wade's (2024) meta-analysis revealed that disordered eating was robustly and consistently associated with greater self-criticism and lower self-compassion across samples. It is well known that even evidence-based treatments for eating disorders (EDs) do not produce long-lasting effects for many patients. Additionally, it is unclear whether existing "mainstream" evidence-based ED treatments effectively reduce shame and self-criticism and increase self-compassion, even when they intend to do so. In this commentary, we assert that Paranjothy and Wade's (2024) findings should inform the integration of self-compassion interventions within ED treatment. We argue that shame, a related but distinct construct, should be strongly considered as a primary intervention target in ED interventions that seek to reduce self-criticism and increase self-compassion. We hypothesize that directly addressing shame and bolstering self-compassion at the start of ED treatment may foster higher engagement and more durable effects. We introduce the potential for adjunctive self-compassion interventions to reduce shame and self-criticism, and enhance self-compassion, alongside or within existing ED treatments. Because self-criticism and shame are shared correlates of EDs and commonly co-occurring psychopathology, we contend with the possibility that self-compassion interventions may produce transdiagnostic effects. Shame, self-criticism, and self-compassion are important intervention targets to explore in future research.

The Intuitive Eating Scale-3: Development and psychometric evaluation.

Intuitive eating has been found to protect against disordered eating and preserve well-being. Yet, there are methodological (length), conceptual (inconsideration of medical, value-based, and access-related reasons for food consumption), and psychometric (item wording) concerns with its most common measure, the Intuitive Eating Scale-2 (IES-2). To address these concerns, we developed the IES-3 and investigated its psychometric properties with U.S. community adults. Across three online studies, we evaluated the IES-3's factorial validity using exploratory factor analysis (EFA; Study 1; N = 957; Mage = 36.30), as well as confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), bifactor-CFA, and bifactor-ESEM (Study 2; N = 1152; Mage = 40.95), and cross-validated the optimal model (Study 3; N = 884; Mage = 38.54). We examined measurement invariance across samples and time, differential item functioning (age, body mass index [BMI], gender), composite reliability, and validity. Study 1 revealed a 12-item, 4-factor structure (unconditional permission to eat, eating for physical reasons, reliance on hunger and satiety cues, body-food choice congruence). In Study 2, a bifactor-ESEM model with a global intuitive eating factor and four specific factors best fit the data, which was temporally stable across three weeks. This model also had good fit in Study 3 and, across Studies 2 and 3, and was fully invariant and lacked measurement bias in terms of age, gender, and BMI. Associations between latent IES-3 factors and age, gender, and BMI were invariant across Studies 2 and 3. Composite reliability and validity (relationships with disordered eating, embodiment, body image, well-being, and distress; negligible relationship with impression management) of the retained model were also supported. The 12-item IES-3 demonstrates strong psychometric properties in U.S. community adults. Research is now needed using the IES-3 in other cultural contexts and social identity groups.

The need for more inclusive measurement to advance equity in eating disorders prevention.

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

Challenges and opportunities for conceptualizing intuitive eating in autistic people.

Although intuitive eating (IE) has become an increasingly adopted intervention target, current conceptualisations of IE have yet to pivot away from (neuro)normative physiology and phenomenology. Autistic individuals commonly report disordered eating behaviours and/or poorer well-being but appear to benefit from adaptive interventions using an affirmative approach. This article uses autism as a case example to summarise challenges related to IE's prevailing conceptualisation, before proposing how future research and current practice can be extended to the autistic population. Scholars are encouraged to evaluate the full 10-principal IE framework while utilising a participatory-led approach. We argue that research using a mixed methods design is urgently needed to comprehensively explore the (re)conceptualisation of IE in autistic people. While IE shows promise for producing positive outcomes in the autistic population, we discuss the potential challenges for research and practice due to its current emphasis on accurate interoception, emotional awareness and processing, and executive functioning. This suggests the need for research and practice to integrate autistic needs and experiences into future developments with an affirmative approach. Public Significance: IE is an effective intervention for reducing disordered eating behaviours. Autistic individuals commonly present disordered eating behaviours and have unique nutritional needs which often require intervention. However, there is limited understanding of IE among the autistic population. Research-informed definitions involving autistic perspectives will support translating the IE framework to this underrepresented population.

Eating disorder risk in rural US adolescents: What do we know and where do we go?

Adolescence is a vulnerable period for the development of eating disorders, but there are disparities in eating disorder risk among adolescents. One population that may be at increased risk but is vastly understudied, is adolescents residing in rural regions within the United States. Rural communities face many mental and physical health disparities; however, the literature on rural adolescent eating disorder risk is nearly nonexistent. In this paper we summarize the scant literature on disordered eating and eating disorder risk and prevalence among rural US adolescents. We also detail eating disorder risk factors that may have unique influence in this population, including socioeconomic status, food insecurity, healthcare access, body image, and weight stigma. Given the presence of numerous eating disorder risk factors, we speculate that rural adolescents may be a particularly vulnerable population for eating disorders and we propose critical next steps in research for understanding eating disorder risk among the understudied population of rural adolescents. PUBLIC SIGNIFICANCE: Rural adolescents may be at increased risk for eating disorders due to disproportionate burden of known risk factors, though this relationship remains understudied. We present a summary of the literature on prevalence and unique risk factors, proposing that this may be a high-risk population. We detail next steps for research to understand eating disorder risk in this population to inform future prevention, identification, and treatment efforts needed in this community.

Is intuitive eating a privileged approach? Cross-sectional and longitudinal associations between food insecurity and intuitive eating.

OBJECTIVE: To examine: (1) cross-sectional and longitudinal associations between measures of food insecurity (FI; household status and youth-reported) and intuitive eating (IE) from adolescence to emerging adulthood; and (2) the association between FI persistence and IE in emerging adulthood. DESIGN: Longitudinal population-based study. Young people reported IE and FI (two items from the US Household Food Security Module) in adolescence and emerging adulthood. Parents provided data on household FI via the six-item US Household Food Security Module in adolescence. SETTING: Adolescents (Mage = 14·3 ± 2 years) and their parents, recruited from Minneapolis/St. Paul public schools in 2009-2010 and again in 2017-2018 as emerging adults (Mage = 22·1 ± 2 years). PARTICIPANTS: The analytic sample (n 1372; 53·1 % female, 46·9 % male) was diverse across race/ethnicity (19·8 % Asian, 28·5 % Black, 16·6 % Latinx, 14·7 % Multiracial/Other and 19·9 % White) and socio-economic status (58·6 % low/lower middle, 16·8 % middle and 21·0 % upper middle/high). RESULTS: In cross-sectional analyses, youth-reported FI was associated with lower IE during adolescence (P = 0·02) and emerging adulthood (P < 0·001). Longitudinally, household FI, but not adolescent experience of FI, was associated with lower IE in emerging adulthood (P = 0·01). Those who remained food-insecure (P = 0·05) or became food-insecure (P = 0·02) had lower IE in emerging adulthood than those remaining food-secure. All effect sizes were small. CONCLUSIONS: Results suggest FI may exert immediate and potentially lasting impacts on IE. As evidence suggests IE is an adaptive approach conferring benefits beyond eating, it would be valuable for interventions to address social and structural barriers that could impede IE.

A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States.

OBJECTIVE: Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS: We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS: Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION: We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE: Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.

OBJETIVO: Los trastornos de la conducta alimentaria (TCA) alguna vez se conceptualizaron como enfermedades que afectaban principalmente a las mujeres blancas, adineradas, un concepto erróneo que informó la investigación y la práctica clínica durante muchos años. Abundante evidencia ahora desacredita este estereotipo, pero no está claro si los tratamientos prevalecientes "basados en la evidencia" se han evaluado en muestras representativas de la diversidad de individuos afectados por los TCA. Nuestro objetivo fue evaluar el informe, la inclusión y el análisis de las variables sociodemográficas en los ensayos controlados aleatorios (ECA) del tratamiento psicoterapéutico para TCA en los Estados Unidos hasta 2020. MÉTODOS: Se realizó una revisión sistemática de los ECA de tratamiento psicoterapéutico de los TCA en los Estados Unidos y se examinó el informe y la inclusión de la identidad de género, la edad, la raza/etnia, la orientación sexual y el estado socioeconómico (ESE) de los participantes inscritos, así como los métodos de reclutamiento, los análisis de poder y la discusión de las limitaciones y la generalización. RESULTADOS: La búsqueda arrojó 58 estudios que cumplieron los criterios de inclusión que datan de 1985. Los informes a veces eran incompletos, ausentes o centrados en el grupo mayoritario racial / de género. Ningún estudio informó participantes con diversidad de género, y los hombres y las personas de color estuvieron subrepresentados en general, con diferencias observadas entre los diagnósticos. Una minoría de los artículos consideró variables sociodemográficas en los análisis o reconoció limitaciones relacionadas con las características de la muestra. Se lograron algunos avances a lo largo de las décadas, con estudios que proporcionan cada vez más datos raciales y étnicos completos, y más hombres incluidos con el tiempo. Aunque la diversidad racial y étnica mejoró un poco, el progreso pareció estancarse en la última década. DISCUSIÓN: Resumimos los hallazgos, consideramos el contexto y los desafíos para los investigadores de ECA, y ofrecemos sugerencias para investigadores, editores de revistas y revisores sobre cómo mejorar la representación, el informe y las prácticas analíticas.

The tension between ethics and rigor when using Amazon MTurk for eating disorder research: Response to commentaries on Burnette et al. (2021).

We respond to commentaries on our 2021 paper "Concerns and recommendations for using Amazon MTurk for eating disorder research." The commentators raised many thoughtful and nuanced points regarding data validity and ethical means of online data collection. We echo concerns about the ethics of recruiting via platforms such as MTurk, and highlight tensions between recommendations for ethical data collection and ensuring data integrity. Especially, we highlight the consistent finding that MTurk workers display elevated (often remarkably so) rates of psychopathology, and argue such findings merit further scrutiny to ensure both data are valid and workers not exploited.

Concerns and recommendations for using Amazon MTurk for eating disorder research.

OBJECTIVE: Our original aim was to validate and norm common eating disorder (ED) symptom measures in a large, representative community sample of transgender adults in the United States. We recruited via Amazon Mechanical Turk (MTurk), a popular online recruitment and data collection platform both within and outside of the ED field. We present an overview of our experience using MTurk. METHOD: Recruitment began in Spring 2020; our original target N was 2,250 transgender adults stratified evenly across the United States. Measures included a demographics questionnaire, the Eating Disorder Examination-Questionnaire, and the Eating Attitudes Test-26. Consistent with current literature recommendations, we implemented a comprehensive set of attention and validity measures to reduce and identify bot responding, data farming, and participant misrepresentation. RESULTS: Recommended validity and attention checks failed to identify the majority of likely invalid responses. Our collection of two similar ED measures, thorough weight history assessment, and gender identity experiences allowed us to examine response concordance and identify impossible and improbable responses, which revealed glaring discrepancies and invalid data. Furthermore, qualitative data (e.g., emails received from MTurk workers) raised concerns about economic conditions facing MTurk workers that could compel misrepresentation. DISCUSSION: Our results strongly suggest most of our data were invalid, and call into question results of recently published MTurk studies. We assert that caution and rigor must be applied when using MTurk as a recruitment tool for ED research, and offer several suggestions for ED researchers to mitigate and identify invalid data.

Like parent, like child? Intuitive eating among emerging adults and their parents.

Intuitive eating (IE) emphasizes relying on hunger and satiety cues to guide eating, and is associated with positive mental health and health-promoting behaviors. Although parents' own eating patterns often shape those of their children, no known research has explored familial associations of IE. The purpose of this cross-sectional, population-based study was to examine IE concordance between emerging adults and their parents, and whether concordance differed across sociodemographic characteristics and weight perceptions. The analytic sample included 891 emerging adults (M age = 22.0) and their primary parent (M age = 50.4) who participated in the population-based, longitudinal EAT and F-EAT 2010-2018 studies. Parents and emerging adults were grouped into dyads based on IE concordance: (1) neither are intuitive eaters; (2) only the emerging adult is an intuitive eater; (3) only the parent is an intuitive eater; (4) both are intuitive eaters. Dyads differed across socioeconomic status (SES), race/ethnicity, and weight perceptions. Concordant dyads who ate intuitively were more likely to be at higher SES and perceive their weight as "about right" than concordant dyads who did not eat intuitively. Asian emerging adults were most likely to belong to concordant non-intuitive eater dyads. Emerging adults who shared their parent's perception their weight was "overweight" were less likely to be intuitive eaters (even if their parents were). In this sample, sociodemographic characteristics and weight perceptions were related to IE concordance among emerging adults and their parents. Lower SES might be an intergenerational barrier to IE disproportionately impacting communities of color, though longitudinal data are needed. Results also suggest rather than motivating healthful eating, perceiving one's weight as "overweight" could hinder IE. Differences across sociodemographic variables likely intersect in meaningful ways, which is an important future research direction.

Lessons learned from a pilot intuitive eating intervention for college women delivered through group and guided self-help: qualitative and process data.

Although disordered eating is prevalent in college women, most will not receive treatment, and existing approaches have limitations. Thus, novel and accessible approaches are warranted. However, few behavioral health interventions progress beyond initial implementation, underscoring the importance of feasibility and acceptability data to guide intervention development and refinement. Stakeholder perspectives can enrich these data, as they can highlight potential mechanisms to investigate in larger randomized-controlled trials (RCTs). The current study examined participant and leader feedback from an 8-week pilot intuitive eating (IE) intervention for college women with disordered eating delivered through group and guided self-help (GSH) modalities. Participants (N = 71) and leaders (N = 8) completed anonymous weekly surveys and exit questionnaires. Overall, the intervention was acceptable and feasible for both participants and leaders. Unique benefits of each modality, such as validation and support in group, and individualization and convenience in GSH, contributed to participant satisfaction and efficacy. Moreover, potential mechanisms of intervention effects, such as interoceptive awareness and self-compassion, were cited in both conditions, and should be explored in a future, fully-powered RCT. Areas for potential refinement include extending the intervention, assessing a hybrid treatment, online delivery, and careful design of a control condition to isolate the intervention's mechanisms of change.

BMI and Disordered Eating in Black College Women: The Potential Mediating Role of Body Appreciation and Moderating Role of Ethnic Identity.

Multiple studies indicate Black American women have disproportionately higher rates of obesity compared with other groups in United States. Although body image is associated with obesity, this relation is understudied among Black women. The purpose of the current study was to (1) examine the relations among body appreciation, body dissatisfaction and disordered eating; (2) assess body appreciation as a mediator of the relation between body mass index (BMI) and disordered eating, and (3) explore ethnic identity as a moderator in this association. Participants were 191 Black women recruited from a mid-Atlantic university. Participants' mean age was 19.16 years (SD = 1.95). Body appreciation partially mediated the relation between BMI and disordered eating behaviors and attitudes, such that women with higher BMIs reported lower body appreciation, which was associated with greater disordered eating symptoms. Ethnic identity was not a significant moderator of the association between BMI and body appreciation. Results support screening Black women with higher BMIs for disordered eating symptomatology and suggest it might be helpful to include body appreciation in interventions for Black women.

An uncontrolled pilot feasibility trial of an intuitive eating intervention for college women with disordered eating delivered through group and guided self-help modalities.

OBJECTIVE: College women engage in high rates of disordered eating behaviors (DEBs), and most do not receive treatment. Campuses lack resources to meet this need, thus accessible and affordable treatment options are important. Intuitive eating (IE) is gaining mainstream interest, but intervention research is scarce, with no known clinical trials in college women. This uncontrolled pilot trial examined the feasibility, acceptability, and preliminary efficacy of an eight-week IE intervention delivered through two potentially accessible and affordable modalities: group and guided self-help (GSH). METHOD: Racially and ethnically diverse college women (N = 71; <50% White) were recruited from a large public Mid-Atlantic university and randomized to group (n = 40) or GSH (n = 31). Assessments occurred at 0 (pre-test), 8 (post-test), and 16 weeks (follow-up). Group participants attended eight weekly 1.5-hour sessions. GSH participants engaged in self-study and had eight weekly 20-minute phone calls. RESULTS: Both conditions demonstrated feasibility, with superior retention and attendance in GSH. Over 90% of those attending at least one session in either condition were retained through follow-up. Both conditions were highly acceptable, and produced medium to large reductions in DEBs, body dissatisfaction, and weight-bias internalization, and improvements in body appreciation, IE, and satisfaction with life from pre- to post-test, which were maintained at follow-up. DISCUSSION: Results of this pilot are encouraging and support the development of a larger randomized controlled trial. Avenues for refinement include strategies to improve feasibility of the group condition, and conducting longer-term follow-up to examine maintenance of effects and the intervention's eating disorder prevention potential.

Racial and ethnic differences in the association between parent-oriented perfectionism and disordered eating in college women.

OBJECTIVE: This study examined the associations between parent-oriented dimensions of perfectionism (parental expectations [PE] and parental criticism [PC]) and eating disorder (ED) symptomatology across racial/ethnic groups. It was hypothesized that parent-oriented perfectionism would be positively associated with ED symptomatology for White and Asian American women. METHOD: Undergraduate women (N = 1,173) completed questionnaires assessing perfectionism, EDs, and demographics. One-way analyses of variance tested differences in PE and PC across racial/ethnic groups; post-hoc Tukey tests probed significant differences. Multiple linear regressions assessed associations between parent-oriented perfectionism and ED symptomatology. Hurdle models tested the association between PE and PC and the frequency and odds of endorsing ED symptomatology. RESULTS: There were significant group differences in PE and PC. PE was positively linked with various ED symptoms in Latina, Asian American, and multiracial women, and was negatively related to purging in multiracial women. PC was positively associated with body dissatisfaction in White, Black, and multiracial women, but displayed differential associations with ED symptomatology in all racial/ethnic groups. DISCUSSION: Levels of parent-oriented dimensions of perfectionism, and their relations to ED symptomatology, might vary across racial/ethnic groups. PE, in particular, is both more elevated, and more strongly linked to eating pathology in Asian American women, whereas PC appears to be especially relevant to ED symptoms in Black women. Findings underscore the importance of considering the role of culture in ED symptomatology. Clinicians and researchers might consider incorporating assessments of parent-oriented perfectionism into their practice.

Integrating eating disorder and weight gain prevention: a pilot and feasibility trial of INSPIRE.

PURPOSE: The current study adapted evidence-based prevention programs to promote positive health behaviors among racially and ethnically diverse young adult women. Two successful programs (The Body Project and the Healthy Weight Intervention) were integrated to evaluate their feasibility, acceptability, and preliminary efficacy in reducing risk for both eating pathology and weight gain. Intervention features extended the previous prevention efforts by emphasizing broad appearance ideals to enhance relevancy for women of color and incorporating distress tolerance and emotion regulation skills training. METHOD: Individuals were excluded if they met criteria for an eating disorder diagnosis and/or obesity, as this was a prevention project. 27 young adult women participated (M age = 18.59; SD = 1.01). The following racial/ethnic groups were represented: 48.1% White, 25.9% Asian, 22.2% Black, and 3.7% Latina. After each meeting, participants completed satisfaction measures and therapists assessed intervention feasibility. Participants also completed comprehensive questionnaires at pretest (baseline), posttest (8 weeks), and 4-week follow-up. RESULTS: Descriptive statistics and content analyses of open-ended questions indicated that the intervention was both acceptable and feasible. Hierarchical linear models evaluating within-subject change over time indicated reductions in several risk factors that were sustained at follow-up: eating pathology, appearance dissatisfaction, thin-ideal internalization, restrained eating, negative affect, emotion dysregulation, and fat intake. BMI did not change from pretest to posttest; however, BMI increased from posttest to follow-up (mean weight increase = 0.34 kg). CONCLUSION: Results suggest that a prevention program designed to be more culturally sensitive is feasible and acceptable. Findings provide preliminary support for reducing the risk of eating pathology and promoting positive health behaviors. LEVEL OF EVIDENCE: Time series with intervention, Level IV. TRIAL REGISTRATION: ClinicalTrails.gov ID: NCT03317587.

What are you losing it for? Weight suppression motivations in undergraduates.

PURPOSE: Accumulating evidence suggests weight suppression (WS) is related to disordered eating and eating disorder (ED) risk in non-clinical samples; however, research to-date has not examined the intentionality of, or motivations for, WS. The purpose of this study was to: (1) qualitatively assess WS motivation in undergraduates, and (2) explore differences in body image and eating behaviors across motivation categories. METHODS: In the first study, responses from 192 undergraduates were evaluated using inductive content analysis; four primary motivation categories emerged: appearance, functional, sports/military, and unintentional. In a second study, 1033 undergraduates indicated their primary WS motivation, if applicable, and completed body image and eating behavior measures. Separate analyses were run by gender; covariates included current body mass index (BMI) and WS. RESULTS: Differences in body image and eating behaviors emerged across motivation categories for both men (p < 0.001) and women (p < 0.001). Appearance-motivated WS in men, and appearance and sports/military-motivated WS in women, were related to greater body dissatisfaction, restraint, thin-ideal internalization, and ED risk. Undergraduates with intentional WS demonstrated higher body dissatisfaction and eating pathology than undergraduates with unintentional or no WS (all ps < 0.05). CONCLUSIONS: Assessing weight history and WS motivations could be a brief, low-cost intervention to improve identification of undergraduates at greatest risk for EDs. This information could be integrated into campus marketing campaigns promoting wellness. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

Real women have (just the right) curves: investigating anti-thin bias in college women.

BACKGROUND: Weight stigma is associated with negative mental and physical health outcomes across the body mass index (BMI) continuum. However, few studies have examined discrimination experienced by people with low body weights. OBJECTIVES: This study explored the presence of anti-thin bias, defined as the belief that individuals at lower body weights have undesirable personality characteristics, in young adult women. Additionally, we examined perceived etiology of weight for women with underweight. METHOD: Participants (N =295 women, age 18.84 ± 2.32) were randomly assigned to read one of the six vignettes about women who differed by race (White and Black) and BMI status (slightly underweight, average weight, and slightly overweight). RESULTS: Negative personality characteristics were more likely to be ascribed to vignette characters with under- or overweight BMIs, compared to characters with average weight BMIs. Participants were more likely to attribute underweight characters' body weight to an eating disorder (ED) compared with average or overweight characters. CONCLUSION: Results suggest that women with under- or overweight BMIs experience greater stigmatization for their body weight than women with average BMIs, underscoring the need for research to investigate weight discrimination across the weight spectrum. LEVEL OF EVIDENCE: Level I, experimental study.

The ignored role of disadvantage in eating disorders.

The misconception that eating disorders are conditions of affluence has shaped research and public understanding for decades. Here, we highlight links between socioeconomic disadvantage and eating disorder risk. With prevailing stereotypes discredited, we argue that considering disadvantage as a key eating disorder risk factor will advance science and reduce disparities.

Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality.

Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.