Gender-based differential item functioning in measures of eating pathology.

OBJECTIVE: Eating disorder (ED) symptoms are common and impairing in males, despite their perception as "female" disorders. As existing self-report symptom measures were developed and primarily validated in women, there is a need to establish the utility of these measures in men. The present study used differential item functioning (DIF) analyses to explore whether item endorsement differed by gender for three commonly used ED symptom measures. METHOD: Participants were undergraduate men (n = 1,083) and women (n = 2,424) from three universities in the United States. Global scores on the Eating Attitudes Test-26 (EAT-26), Eating Disorder Examination Questionnaire (EDEQ), and Eating Disorder Diagnostic Scale for DSM-IV (EDDS) were examined. Tests of DIF were conducted by regressing each item against its composite scale score, and then comparing fit and variance explained (R2 ) to a model with the interaction of item*gender. The clinical significance threshold for DIF is ΔR2 ≥ 0.13. RESULTS: There was no evidence of clinically significant DIF within the EAT-26, EDEQ, or EDDS. DISCUSSION: Findings suggest that the examined measures perform similarly for undergraduate men and women, supporting their use in nonclinical male samples. However, development and testing of items reflecting ED symptoms that more commonly occur in males (e.g., muscularity-oriented behaviors) is encouraged.

Thin-ideal internalization: How much is too much?

Internalization of the thin-ideal is a risk factor for eating disorders that frequently persists into recovery and increases patient risk for relapse. Addressing thin-ideal internalization as a core element of eating disorder prevention and treatment produces significant reductions in eating pathology. However, research has not yet quantified levels of thin-ideal internalization that may signal increased versus decreased risk for disordered eating. To address this gap in the literature, receiver operating characteristic (ROC) curve analysis was used to identify a thin-ideal internalization cutoff score that signified clinically-meaningful eating disorder pathology. 787 college women (age M = 20.17, SD = 2.41; BMI M = 23.58, SD = 5.29) were classified as "healthy" (N = 717) or those with significant disordered eating (N = 70) using established clinical cutoffs for the Eating Disorder Examination-Questionnaire. ROC curve analysis was used to test the performance of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) Internalization: Thin/Low Body Fat subscale in predicting disordered eating status, and to identify a cutoff score that maximized sensitivity and specificity to discriminate between healthy and disordered eating samples. Mean SATAQ-4 internalization scores were 3.29 (SD = 0.92) and 4.27 (SD = 0.62) for healthy and disordered eating participants, respectively. The SATAQ-4 internalization scores were good predictors of disordered eating status (area under the curve = 0.81, 95% CI: 0.76-0.86). The optimal cutoff of 3.78 (measured on a 1-5 Likert scale) yielded a sensitivity of 0.81 and specificity of 0.64. Overall, results provide preliminary support for the discriminant validity of SATAQ-4 thin internalization scores and suggest that even moderate levels of thin-ideal internalization may be predictive of clinically-significant eating pathology. It may be important for prevention and intervention work to actively seek to reduce internalization levels below this clinical cutoff, though future work is needed to bear this out.

Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia.

Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative outcomes may help to elucidate the prominence of specific risk factors within a given Western society and guide associated interventions. Women from the United States (US), Italy, England, and Australia completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Analysis of covariance controlling for age and BMI indicated significant cross-country differences for all SATAQ-4 subscales. Results typically indicated higher levels of appearance-ideal internalization and appearance pressures in the US and lower levels in Italy; however, associated effect sizes were generally small. A medium effect of country was observed for peer-appearance pressures, which were highest in the US compared with all other countries. Repeated-measures analysis of variance and paired samples t tests conducted within each country identified thin-ideal internalization and media appearance pressures as the predominant risk factors for all four countries. Overall, findings suggest more cross-country similarities than differences, and highlight the importance of delivering interventions to address thin-ideal internalization and media appearance pressures among women from Western backgrounds.Level of evidence Descriptive study, Level V.

Self-objectification and disordered eating: A meta-analysis.

OBJECTIVE: Objectification theory posits that self-objectification increases risk for disordered eating. METHOD: The current study sought to examine the relationship between self-objectification and disordered eating using meta-analytic techniques. RESULTS: Data from 53 cross-sectional studies (73 effect sizes) revealed a significant moderate positive overall effect (r = .39), which was moderated by gender, ethnicity, sexual orientation, and measurement of self-objectification. Specifically, larger effect sizes were associated with female samples and the Objectified Body Consciousness Scale. Effect sizes were smaller among heterosexual men and African American samples. Age, body mass index, country of origin, measurement of disordered eating, sample type and publication type were not significant moderators. DISCUSSION: Overall, results from the first meta-analysis to examine the relationship between self-objectification and disordered eating provide support for one of the major tenets of objectification theory and suggest that self-objectification may be a meaningful target in eating disorder interventions, though further work is needed to establish temporal and causal relationships. Findings highlight current gaps in the literature (e.g., limited representation of males, and ethnic and sexual minorities) with implications for guiding future research.

On the measurement of thin-ideal internalization: Implications for interpretation of risk factors and treatment outcome in eating disorders research.

OBJECTIVE: Although the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) and Ideal Body Stereotype Scale (IBSS) are used interchangeably to assess thin ideal internalization, limited work has examined the assumption that the two measures index the same construct. METHOD: The current study utilized confirmatory factor analysis to examine whether these measures capture a single construct (one-factor), two constructs (two-factor), or both shared and unique constructs (bifactor). The SATAQ-4R-Internalization: Thin/Low Body Fat subscale and IBSS-Revised were administered to 1,114 college females. RESULTS: A bifactor model provided the best fit to the data. Further, the SATAQ-4R was more strongly related to disordered eating and body satisfaction than the IBSS-R. DISCUSSION: Results indicate that the two most commonly used measures of internalization capture both shared and unique constructs. While both measures appear to contribute to the assessment of a global internalization factor, the SATAQ-4R may be better suited to assess personal acceptance of and desire to achieve a thin body, while the IBSS-R may be better suited to assess an awareness or acknowledgement of broader sociocultural ideals (e.g., toned, shapely bodies). Continued psychometric investigation of the scales is recommended in order to ensure targeted assessment of the intended constructs.

Identifying a male clinical cutoff on the Eating Disorder Examination-Questionnaire (EDE-Q).

OBJECTIVE: Evidence suggests that eating disorders (EDs) may be under-detected in males. Commonly used measures of EDs such as the Eating Disorder Examination-Questionnaire (EDE-Q) were initially developed within female samples, raising concern regarding the extent to which these instruments may be appropriate for detecting EDs in males. The current study used receiver operating characteristic curve analysis to (a) examine the accuracy of the EDE-Q global score in correctly classifying males with and without clinically significant ED pathology, and (b) establish the optimal EDE-Q global clinical cutoff for males. METHOD: Participants were a clinical sample of 245 male ED patients and a control sample of 205 male undergraduates. RESULTS: Eating Disorder Examination-Questionnaire global scores demonstrated moderate-high accuracy in predicting ED status (area under the curve = 0.85, 95% CI: 0.82-0.89). The optimal cutoff of 1.68 yielded a sensitivity of 0.77 and specificity of 0.77. DISCUSSION: Overall, results provide preliminary support for the discriminant validity of EDE-Q scores among males. However, concerns remain regarding the measure's ability to comprehensively assess domains of disordered eating most relevant to males. Therefore, careful attention to the possibility for measurement bias and continued evaluation of the scale in males is encouraged.

A content analytic comparison of fitspiration and thinspiration websites.

OBJECTIVE: "Pro-ana" or Thinspiration websites are internet sites that support weight loss and eating disorders. Fitspiration websites are a newer type of site that supposedly advocates a fit and healthy lifestyle. METHOD: The first 10 images from a sample of 50 Fitspiration and 50 Thinspiration websites, chosen using a standard internet search protocol, were rated on a variety of weight, eating, and appearance characteristics. χ(2) analyses were conducted to compare website content. RESULTS: Thinspiration sites featured more content related to losing weight or fat, praising thinness, showng a thin pose, and providing food guilt messages than Fitspiration sites. However, sites did not differ on guilt-inducing messages regarding weight or the body, fat/weight stigmatization, the presence of objectifying phrases, and dieting/restraint messages. Overall, 88% of Thinspiration sites and 80% of Fitspiration sites contained one or more of the coded variables. DISCUSSION: Prior research has examined Thinspiration websites and noted the potentially hazardous messages contained on these sites. This content analysis indicates that sites supposedly devoted to healthy pursuits (fitness) may also contain thematically similar content.

Differential impact of upward and downward comparisons on diverse women's disordered eating behaviors and body image.

OBJECTIVE: Etiological models of disordered eating are limited in their consideration of racial/ethnic differences in risk factors. Appearance comparisons are consistent predictors of disordered eating outcomes, but research predominantly examines these associations among White women and overlooks the potential differential impact of upward (comparing to someone perceived as better off) versus downward comparisons (comparing to someone perceived as worse off). This study investigated race/ethnicity as a moderator of the associations between upward and downward appearance comparisons and disordered eating outcomes and body satisfaction of young adult women. METHOD: Measures of upward and downward appearance comparisons, body satisfaction, and disordered eating were administered to 1,014 young adult women. A multiple group (by race/ethnicity) path analysis was estimated using maximum likelihood estimation for each disordered eating and body satisfaction outcome, controlling for age and BMI. RESULTS: Upward comparisons were associated with higher levels of disordered eating behaviors and lower body satisfaction for women of all racial/ethnic groups. Downward appearance comparisons emerged as detrimental for Hispanic/Latina women, but were protective for Asian and White women. DISCUSSION: Findings challenge the belief that appearance comparisons impact all women similarly and that downward comparisons are universally protective, a position often promulgated by clinical treatment approaches. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:519-523).

Genetic and environmental influences on thin-ideal internalization across puberty and preadolescent, adolescent, and young adult development.

OBJECTIVE: Mean-levels of thin-ideal internalization increase during adolescence and pubertal development, but it is unknown whether these phenotypic changes correspond to developmental changes in etiological (i.e., genetic and environmental) risk. Given the limited knowledge on risk for thin-ideal internalization, research is needed to guide the identification of specific types of risk factors during critical developmental periods. The present twin study examined genetic and environmental influences on thin-ideal internalization across adolescent and pubertal development. METHOD: Participants were 1,064 female twins (ages 8-25 years) from the Michigan State University Twin Registry. Thin-ideal internalization and pubertal development were assessed using self-report questionnaires. Twin moderation models were used to examine if age and/or pubertal development moderate genetic and environmental influences on thin-ideal internalization. RESULTS: Phenotypic analyses indicated significant increases in thin-ideal internalization across age and pubertal development. Twin models suggested no significant differences in etiologic effects across development. Nonshared environmental influences were most important in the etiology of thin-ideal internalization, with genetic, shared environmental, and nonshared environmental accounting for approximately 8%, 15%, and 72%, respectively, of the total variance. DISCUSSION: Despite mean-level increases in thin-ideal internalization across development, the relative influence of genetic versus environmental risk did not differ significantly across age or pubertal groups. The majority of variance in thin-ideal internalization was accounted for by environmental factors, suggesting that mean-level increases in thin-ideal internalization may reflect increases in the magnitude/strength of environmental risk across this period. Replication is needed, particularly with longitudinal designs that assess thin-ideal internalization across key developmental phases.

Psychometric properties of the Body Esteem Scale for Adolescents and Adults in an early adolescent sample.

BACKGROUND: Validation of body esteem measures in pre- and early adolescent male and female populations is essential as gender differences regarding weight and body size concerns often emerge during this developmental period. OBJECTIVE: The purpose of the current study was to analyze psychometric properties of the Body Esteem Scale for Adolescents and Adults (BESAA) in order to determine the utility of this instrument in a population of early adolescent males and females. METHODS: A cross-sectional survey was completed by 86% of sixth-graders (N = 299) at a single US middle school. RESULTS: Confirmatory factor analysis provides support for two interpretable and interrelated subscales of the BESAA [Body esteem (BE)-weight and BE-appearance], both of which exhibit good internal consistency reliability and evidence of concurrent validity based on correlations with self-esteem and BMI. However, the following concerns about the BESAA were identified: (a) certain scale items may lack structural invariance across gender and developmental age group; (b) multiple items demonstrated a tendency to load on both factors; (c) several item pairs are similar in wording and/or meaning and show a tendency for correlated errors; and (d) an additional BE dimension assessing views about one's muscle build and strength may be needed to fully capture body esteem among adolescent males. CONCLUSIONS: Findings suggest cognitive interviewing and additional psychometric studies are needed for modifying the BESAA for use among early adolescents.

TikTok, TikTok, the time is now: Future directions in social media and body image.

This article synthesizes practical strategies and future directions proposed by contributors to the special issue in Body Image on social media and body image. It also moves beyond the contributions of the special issue in an effort to provide additional guidance to researchers, clinicians, educators, and policymakers. First, we recommend that research on social media and body image extend beyond convenience sampling of young, White women and include children and older adults, boys and men, and underrepresented groups. Second, we urge researchers to move away from simplistic measures of social media and to utilize mixed-methods approaches. Third, we advocate for the development of new theories that can be tested longitudinally and that capture the unique influences of social media, rather than relying solely on existing models that were developed for traditional media. Fourth, we provide recommendations regarding practical strategies, such as the inclusion of media literacy campaigns, increased research on the role of reality check disclaimers, and further examination regarding the role of body positivity in prevention and intervention efforts. Finally, we end with recommendations regarding advocacy, such as using social media to harness positive efforts and partnering with social media companies regarding their use of algorithms.

Translation and psychometric properties of the Chinese version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) in college students.

The current study aimed to translate the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) into Mandarin Chinese and to examine its psychometric properties. In Study 1 (N = 842, 427 women, 415 men), exploratory factor analysis supported a 4-factor solution for the Mandarin Chinese SATAQ-4, namely Internalization: Thin/Low body fat, Internalization: Muscular/Athletic, Pressures: Family/Peers, and Pressures: Media. Evidence also supported the high internal consistency and convergent validity of the male-subject and female-subject versions of Mandarin Chinese SATAQ-4. In Study 2 (N = 497, 290 women), confirmatory factor analyses supported the previously found 4-factor model, after allowing correlation between residuals of three pairs of items. In Study 3 (N = 294, 129 women), we examined the 3-month test-retest reliability across gender, and the results showed satisfactory ICC for both women (ICC =0.53-0.79) and men (ICC =0.56-0.66). Taken together, the male-subject and female-subject versions of the Mandarin Chinese SATAQ-4 are reliable and valid in evaluating sociocultural attitudes towards appearance.

Integrating social media variables as predictors, mediators, and moderators within body image frameworks: Potential mechanisms of action to consider in future research.

In this article, we consider how social media variables may be integrated as predictors, mediators, and moderators within dominant theoretical frameworks of body image in order to identify potential mechanisms of action that can be empirically examined in future research and used to direct prevention and intervention efforts. To achieve this goal, we first articulate social media variables that have been investigated as predictors, mediators, and moderators in body image research. Next, we present the following critical and sociocultural theoretical frameworks: social comparison theory, tripartite influence model, objectification theory, developmental theory of embodiment, acceptance model of intuitive eating, cultivation theory, and uses and gratifications theory. Additionally, we present the theory of development of critical body awareness, a newly developed model that may provide further insight regarding the relationships between social media and body image-related outcomes. For each model, we articulate extant research that has explored social media variables within its context and explicate how social media variables could potentially be studied as predictors, mediators, and moderators within its structure. To conclude, we address pertinent limitations and gaps within this research space that could direct future research across the theoretical frameworks.

Validation of an adapted Italian-language version of the Sociocultural Attitudes Toward Appearance Questionnaire-3 (SATAQ-3), within a female population: the Sociocultural Attitudes Toward Appearance Questionnaire - Social Media (SATAQ-SM).

Sociocultural Attitudes Towards Appearance Questionnaire-Social Media (SATAQ-SM) is a self-administered questionnaire for the evaluation of social media pressure and internalization of beauty standards. This study aims to validate the SATAQ-SM an adapted Italian version of the Sociocultural Attitudes Towards Appearance Questionnaire third version (SATAQ-3). Confirmatory factor analysis was used to investigate whether the empirical data fitted the four-factor structure of SATAQ-3. Assessment of goodness-of-fit was based on standard model fit criteria: relative χ2 value (χ2/df), Root Mean-Squared Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI). Internal consistency was assessed using McDonald's omega. Criterion validity was calculated by correlating the SATAQ-SM factors scores with the total score of the Rosenberg self-esteem scale (RSES) and Eating Attitudes Test (EAT-26). Four-hundred and eighty-five females agreed to participate in the study. The four-factor model appears to be confirmed by the fit indices: χ2/df = 3.73, RMSEA = 0.07, CFI = 0.99 and TLI = 0.99. All the items defining the four factors had a factor loading of ≥0.40. McDonald's omega of the entire questionnaire was equal to 0.95 and for the four subscales it did not assume values lower than 0.81. The correlations between the factor score of SATAQ-SM and the RSES were all negative and statistically relevant (p < 0.001); the correlations between the scores of the SATAQ-SM subscales and the total score of the EAT-26 are all positive and statistically significant. SATAQ-SM demonstrated good psychometric properties to assess the influence of social media on body image perception related to social media.

Genetic and environmental influences on thin-ideal internalization.

OBJECTIVE: Current research on the etiology of thin-ideal internalization focuses on psychosocial influences (e.g., media exposure). The possibility that genetic influences also account for variance in thin-ideal internalization has never been directly examined. This study used a twin design to estimate genetic effects on thin-ideal internalization and examine if environmental influences are primarily shared or nonshared in origin. METHOD: Participants were 343 postpubertal female twins (ages: 12-22 years; M = 17.61) from the Michigan State University Twin Registry. Thin-ideal internalization was assessed using the Sociocultural Attitudes toward Appearance Questionnaire-3. RESULTS: Twin modeling suggested significant additive genetic and nonshared environmental influences on thin-ideal internalization. Shared environmental influences were small and non-significant. DISCUSSION: Although prior research focused on psychosocial factors, genetic influences on thin-ideal internalization were significant and moderate in magnitude. Research is needed to investigate possible interplay between genetic and nonshared environmental factors in the development of thin-ideal internalization.

Psychological consequences of obesity: weight bias and body image in overweight and obese youth.

Over the past several decades, the prevalence of overweight and obesity in children has increased considerably. While it has been widely documented that childhood obesity is related to a variety of negative health consequences, and numerous campaigns have focused on increasing physical activity and healthy food choices in children, less research has focused on the negative psychological consequences of childhood obesity, namely body image disturbance. This article examines research on body image disturbance in overweight/obese children, comorbidity of psychological disorders and childhood overweight/obesity, and factors that contribute to body image disturbance in overweight and obese youths. Additionally, the authors present research pertaining to treatment and prevention of body image disturbance in overweight/obese youths and discuss potential future directions for research, prevention and advocacy.

The dangers of the rabbit hole: Reflections on social media as a portal into a distorted world of edited bodies and eating disorder risk and the role of algorithms.

The relationship between social media usage and body image has been well-established in the literature; however, social media companies' use of algorithms may intensify this association, as algorithms provide viewers with personalized content that is often more extreme, less monitored, and designed to keep users engaged for longer periods of time. This article details the recent media coverage of algorithms, revelations by former social media employees regarding the problematic usage of algorithms, and revelations that social media companies are aware of the harm posed by their implementation of algorithms, particularly for young, vulnerable users. We provide recommendations for influencers, educators, researchers, clinicians, parents, and users, and conclude that it is ultimately the responsibility of the social media corporations to protect and enhance the well-being of their users.

An abbreviated 10-item, two-factor version of the Body Image Quality of Life Inventory (BIQLI-10): The U.S. Body Project I.

The objective of this study was to re-examine the factor structure of the Body Image Quality of Life Inventory (BIQLI), a measure that quantifies perceived effects of one's body image on various aspects of psychosocial functioning. Data on the 19-item BIQLI from a community sample of 11,620 U.S. men and women were split into cross-validation samples and underwent exploratory and confirmatory factor analysis. An abbreviated 10-item, two-factor version of the BIQLI (BIQLI-10) was identified. The BIQLI-10 measures Social Relations & Psychological Well-Being with one subscale and Appearance & Body Management Activities with the other. Internal consistency was high for each subscale. The BIQLI-10 largely retained the convergent validity of the original 19-item BIQLI, as evidenced by nearly identical correlations with appearance evaluation, overweight preoccupation, body surveillance, appearance pressures, and appearance ideal internalization. Results also supported strong measurement invariance for the BIQLI-10 by age group, gender, sexual orientation, racial group, and weight status. Findings from this study suggest researchers may use this abbreviated version to increase nuance in the measurement of body image quality of life and reduce participant burden without compromising the psychometric integrity of the BIQLI. Further, results support the comparison of BIQLI-10 subscale scores across diverse groups.

Development and validation of a measure of curvy ideals internalization.

Several sociocultural female body ideals exist - thin, muscular/athletic, and, more recently, curvier ideals, which research specifically suggests are more prevalent among Black women. Two validated measures assess women's desire for curvier bodies, but neither assess certain facets of curvy ideals (e.g., thick vs. slim-thick) separately. We developed and validated the Curvy Ideals Internalization (CII) Scale, to be used alone or alongside existing measures of appearance ideal internalization. Focus groups among racially/ethnically diverse women informed initial items. A sample of 897 White (37.1%), Black (34.2%), and biracial Black and White (28.7%) U.S. women completed the initial 37-item CII to determine factor structure, narrow the item pool, and examine validity and reliability. A separate sample (N = 366) of U.S. Black, White, and biracial women completed the CII to confirm the factor structure. The final CII has eleven items, with factors assessing thick/curvy ideal internalization and facets of slim-thick ideal internalization: thin waist and large breast size. The CII has adequate internal consistency, test-retest reliability, construct validity, and factorial validity. The CII is appropriate for use among Black, White, and biracial women to assess internalization of curvier body ideals and needs to be validated in more diverse samples.

Sexual orientation differences in pathways from sociocultural and objectification constructs to body satisfaction: The U.S. Body Project I.

Objectification theory and the tripartite influence model provide useful frameworks for understanding the body image experiences of men and women. However, there is little systematic investigation of how sexual orientation moderates the links between these constructs and body image satisfaction. It has been hypothesized, for example, that the associations of surveillance (i.e., monitoring of one's appearance due to objectification by others) would be strongest for groups targeted by the male gaze (e.g., gay men, lesbian women, and bisexual men and women). Here we proposed an integrated sociocultural model and examined these pathways in multigroup structural equation models in a national sample of heterosexual, bisexual, and lesbian women (ns = 5395; 598; 213, respectively), and heterosexual, bisexual, and gay men (4869; 194; and 194, respectively) aged 18-65 years. Sexual orientation moderated some of these pathways. The most consistent pattern was that appearance pressures were internalized to a greater extent among bisexual participants. The pathways to poorer body image were generally similar among heterosexual and gay/lesbian men and women. These findings highlight the importance of examining sexual orientation-specific influences on body image across diverse groups, as well as the commonalities in the experiences of men and women across sexual orientations.