Evaluation of Teen BodyWise: A pilot study of a body image group adapted for adolescent inpatients with anorexia nervosa.

PURPOSE: Body image disturbance is a key characteristic of anorexia nervosa (AN); however, research into these difficulties among adolescents with AN is limited and is yet to assess the best treatments for this population. METHODS: Fifty-two adolescents receiving inpatient treatment for AN attended Teen BodyWise, an eight-session body image group adapted for adolescents. Measures assessing shape and weight concerns, ability to discuss body image, sociocultural attitudes, body avoidance, body checking, and motivation were given before and after the group, and participant feedback was elicited. RESULTS: Significant improvements were found for shape and weight concerns, ability to discuss body image, body checking and sociocultural attitudes. Participants were generally satisfied with the group and found it helpful, yet some aspects were experienced as challenging. CONCLUSIONS: Teen BodyWise has potential benefits for adolescents with AN. Controlled research is needed to determine the effectiveness of Teen BodyWise. LEVEL OF EVIDENCE: Evidence obtained from multiple time series with or without the intervention, such as case studies, Level IV.

Food volume effects on intake and appetite in women with binge-eating disorder and weight-matched controls.

OBJECTIVE: Our study examined the effect of food volume on later intake and appetite ratings in 15 women with binge eating disorder (BED) and 15 healthy control women. METHOD: On nonconsecutive days, lower-volume (250 ml/171 kcal) and higher-volume milk-based preloads (500 ml/171 kcal) were served in counterbalanced order. Thirty minutes later, appetite ratings and intake at a buffet-style test-lunch were assessed. RESULTS: Higher-volume preloads decreased hunger, desire to eat, excitement about eating, desire for dessert, and loss of control over eating at test meals, relative to lower-volume preloads. Test-meal intake was greater among BED participants than controls; intake did not differ by preload volume. BED participants' desire to eat, prospective consumption, excitement about eating, and desire for meals and desserts were higher than controls' ratings. CONCLUSION: Higher-volume foods decreased hunger and related appetite ratings. Differences in food intake and appetite between BED and control participants provide further evidence for the validity of test meals to assess binge eating.

Energy density effects on food intake, appetite ratings, and loss of control in women with binge eating disorder and weight-matched controls.

Individuals with binge eating disorder have increased gastric capacity and may require excessive food intake and increased volume in the stomach to produce satiation. The present study examined whether lower energy density (ED) meals lead to lower energy intake more than higher-ED meals in women with binge eating disorder (BED) and weight-matched controls. Women with BED (n=15) and healthy weight-matched controls (n=15) were instructed to consume as much as they wished during two test meals on non-consecutive days. Participants were served two hedonically similar versions of a pasta salad (19% protein, 50% carbohydrate, 31% fat): low-ED (1.0 kcal/g) and high-ED (1.6 kcal/g), and food intake and appetite ratings were assessed. Energy intake was significantly lower in the low-ED condition than in the high-ED condition across all participants. BED participants were more likely to report greater prospective consumption, desire for dessert, loss of control over eating, and less enjoyment after meals. Decreasing the energy density of food consumed may help target disturbances in satiation in women with frequent binge eating.

Psychopathology Factors That Affect the Relationship Between Body Size and Body Dissatisfaction and the Relationship Between Body Dissatisfaction and Eating Pathology.

Although high body mass index (BMI) alone does not invariably lead to body dissatisfaction (BD) and BD alone does not invariably lead to eating pathology (EP), research has suggested that there are clear relationships between each predictor and its respective criterion. We have a limited understanding of the factors that explain why some women at higher risk for BD (because of their BMI) do not report being dissatisfied with their bodies and why some women who are highly dissatisfied, do not engage in pathological eating behaviors. The present study examined such factors. A university sample of New Zealand women (N = 166) completed the Personality Assessment Inventory (Morey, 1991) and questionnaires measuring BD and EP. The tendency to report lower BD than would be predicted by one's BMI, and the tendency to report lower EP than would be expected based on one's BD, were characterized by lower overall distress (i.e., lower levels of anxiety and depression) and greater mood stability compared to those who followed the predicted outcome. Greater understanding of the factors that protect high-risk women from BD and EP may contribute to prevention and intervention strategies.

An examination of risk factors that moderate the body dissatisfaction-eating pathology relationship among New Zealand adolescent girls.

BACKGROUND: Eating disorders (EDs) and their subclinical variants are important health concerns for adolescent girls, and body dissatisfaction is a more common yet often debilitating experience that typically precedes the development of an ED. Despite this fact, little is known about what makes girls who are dissatisfied with their bodies more likely to engage in pathological eating behaviors. The present study explored eating pathology among a sample of adolescent girls from New Zealand and examined a variety of established risk factors that may moderate the relationship between body dissatisfaction (BD) and eating pathology. METHODS: Adolescent girls aged between 14 and 18 (N = 231) completed questionnaires assessing eating pathology, BD, negative affect, perfectionism, self-esteem, teasing and sociocultural pressure. Regression analyses tested for moderator effects to examine which variables moderated the relationship between BD and eating pathology. RESULTS: The analyses indicated that high levels of socially prescribed and self-oriented perfectionism, negative affect, perceived pressure from the media, and low levels of self-esteem all strengthened the relationship between BD and eating pathology. CONCLUSIONS: The results highlight potential factors that may make adolescent girls who are dissatisfied with their bodies more susceptible to eating pathology.

Loss of control over eating reflects eating disturbances and general psychopathology.

This study examined the clinical significance of the loss of control over eating as a key component of eating disorders. It investigated the association of eating-related psychopathology and general psychopathology with objective bulimic episodes (OBEs; experiencing a loss of control while consuming large amounts of food) and subjective bulimic episodes (SBEs; experiencing a loss of control while consuming small/moderate amounts). A community sample of 81 women with a range of disordered eating was recruited: binge-eating disorder, bulimia nervosa, subclinical eating disturbances, or no eating disorders. They were interviewed using the Eating Disorder Examination and completed measures of eating-related and general psychopathology. Both OBE and SBE frequencies correlated significantly with measures of eating-related and general psychopathology, and no significant differences were found between the magnitudes of the correlations with either binge episode type. SBE frequency significantly and independently predicted global eating disorder psychopathology. The loss of control over eating, without consuming large amounts of food, was as closely associated with specific eating disorder psychopathology and general mental health as were traditionally defined OBEs. SBEs may be an important target of treatment and should be considered for future diagnostic classifications of eating disorders.

Quality of friendships and motivation to change in adolescents with Anorexia Nervosa.

This study explored the relationship between quality of friendships, motivation to change and peer support among young people receiving inpatient treatment for Anorexia Nervosa (AN). Thirty participants were recruited from three inpatient wards. Questionnaires assessed motivational stage, friendship functions and characteristics of friendships specific to AN. Three friendship functions - Help, Intimacy and Self-Validation - were significantly and positively correlated with greater motivational stage. Describing friends on the ward as supportive of adherence to the treatment program was positively associated with greater motivational stage and higher quality friendships. The association between motivation, friendship quality and peer support in treatment identifies close and supportive friendships among young people with AN as a potential target to improve outcomes.

Childhood obesity stigma: association with television, videogame, and magazine exposure.

Although the stigmatization of obesity among children is highly prevalent, its origins and relationship to mass media exposure are largely unknown. Ninety boys and 171 girls aged 10-13 years (mean BMI=19.84) were asked to rank, in order of liking, 12 figures of peers depicted both with and without various disabilities or obesity, and to rate their attitudes towards the obese child on visual analogue scales. Weekly time spent watching television, watching videogames, and reading magazines on weekdays and weekends was assessed. Total media use, magazine use, and videogame use were significantly correlated with more negative reactions to obese girls and boys. Regression analyses revealed that greater dislike of obese children relative to their non-overweight peers was uniquely predicted by magazine reading time. Thus, media exposure was associated with stigmatizing attitudes towards obese children. Mass media sources may lead children to devalue and stigmatize peers with above-average body weights.

Assessment of obesity stigmatization in children and adolescents: modernizing a standard measure.

OBJECTIVE: Stigmatization of overweight children is highly prevalent. However, the measurement of stigma has varied widely across studies. An up-to-date version of a commonly used measure of weight-related stigma is needed. RESEARCH METHODS AND PROCEDURES: Poser 5 (DAZ software) was used to develop 12 modernized figures, using three-dimensional models rendered as high-resolution images. They depicted one overweight, one non-overweight, and four disabled children of each sex. Children recruited from public and private schools (N = 261; mean age, 11.3 years; median BMI z-score = 0.33; 77.0% white, 11.5% Asian, and 7.7% Maori) ranked these figures in order of liking. Participants also ranked traditionally used line drawings depicting comparable images. Participants rated each new figure on measures of liking and stereotypical attributes on 100-mm visual analog scales (VASs). RESULTS: Rankings of liking of the new figures were highly correlated with rankings of corresponding old figures, especially for overweight figures [boys: rho (77) = 0.72, p < 0.001; girls: rho (153) = 0.68, p < 0.001]. Rankings of overweight and other figures were also highly correlated with VAS assessment of liking and with a composite, internally consistent VAS measure of liking and stereotypical attributes. Only negative stereotypes about the intelligence of overweight boys and girls contributed significantly to the variance in liking. DISCUSSION: An updated and modernized tool for assessing children's weight stigma was developed and its construct validity supported. The present findings suggest that stereotypes about low intelligence may contribute to weight stigma among children. More research is needed on the causes and components of weight stigma so that it can be effectively reduced.