Adaptation and implementation of body project as a universal body image program in Mexico and Latin America.

The Body Project (BP) intervention for body image issues is supported by extensive efficacy and effectiveness research, most of which has been conducted in the United States. The BP uses cognitive dissonance to help participants critique the ideal appearance through written, verbal, and behavioral exercises. This reduces the internalization of the appearance ideal, which in turn decreases body dissatisfaction symptoms and, in some individuals, the onset of eating disorders. To broadly implement this program in Mexico and Latin America, Comenzar de Nuevo (CdN), a non-profit organization for eating disorder treatment, partnered with the Body Project Collaborative in 2014. Together, they created a training and implementation infrastructure. This paper explores the adaptation of BP and its implementation in Mexico and Latin America. We used sustainable business, marketing, and educational models to fulfill CdN's mission to reduce eating disorder risk factors, including weight stigma, in the Latin American region. By integrating strategies to combat weight stigma within our program delivery, we strive to contribute to a more inclusive and supportive environment. We trained master trainers, regular trainers, and/or group facilitators from Argentina, Bolivia, Colombia, Costa Rica, Chile, Dominican Republic, El Salvador, Guatemala, Mexico, Panama, and Spain; and implemented the BP in 15 public schools supported by sponsorship programs. This paper provides crucial lessons learned, future directions, and implications for dissemination and implementation efforts in this region of the world.

Association of BMI trajectories with cardiometabolic risk among low-income Mexican American children.

BACKGROUND: The aim of this study was to identify distinct trajectories of BMI growth from 2 to 7.5 years and examine their associations with markers of cardiometabolic risk at age 7.5 years among a sample of low-income Mexican American children. METHODS: This longitudinal cohort study recruited 322 mother-child dyads to participate prenatally and at child age 2, 3, 4.5, 6, and 7.5 years. Child height/weight, waist circumference, and blood pressure were assessed at each time point. Blood was collected from child at 7.5 years. RESULTS: Covarying for birthweight, three BMI trajectories were identified: Low-Stable BMI (73% of the sample), High-Stable BMI (5.6% of the sample), and Increasing BMI over time (21.4% of the sample). The High-Stable and Increasing BMI classes had higher waist circumference and systolic blood pressure and lower HDL-c than the Low-Stable BMI class (ps < 0.05). Among children with BMIs below the 85th percentile, 16% had three or more cardiometabolic risk indicators. CONCLUSIONS: BMI classes were consistent with existing literature. For youth, standard medical practice is to examine cardiometabolic risk indicators when BMI is high; however, this practice would miss 16% of youth in our sample who exhibit cardiometabolic risk but do not screen in based on BMI. IMPACT: Research indicates Mexican American youth are at risk for cardiometabolic dysregulation relative to other ethnic groups, yet there is a paucity of longitudinal research. An Increasing BMI and a High-Stable BMI class were associated with larger waist circumference, higher systolic blood pressure, and lower HDL cholesterol than the Low-Stable BMI class. BMI trajectories in childhood predict cardiometabolic risk indicators. As the sole screener for deciding when to test cardiometabolic indicators, BMI alone will miss some children exhibiting cardiometabolic dysregulation.

The Interdependent Nature of Mother's and Children's Temperament and Eating Behaviors on Weight.

OBJECTIVES: The family environment is an important contextual factor for parent and child weight within families. Using an Actor-Partner Interdependence Model, the current study examined (1) the effect of child and mother temperament (i.e., negative affectivity, effortful control, and impulsivity) on mother and child weight, (2) the effect of mother eating behaviors on mother and child weight, and (3) how temperament might moderate the relationships between mother eating behaviors and mother and child weight. METHODS: The sample consisted of 220 mother-child dyads with children between 4 and 6 years of age (66.8% classified as low-, 25.9% middle-, and 5.5% high-income). Mothers completed questionnaires on their own temperament and eating behaviors as well as child temperament. Weight measures were assessed in the laboratory for both mother and child. RESULTS: Mother's negative affectivity and impulsivity were negatively related to mother's weight while children's impulsivity was positively related to children's and mother's weight. Mother's eating behaviors were also positively related to mother's weight. The interaction between child impulsivity and mother eating behaviors was significant; the association of mother eating behaviors with mother weight depended on child impulsivity. Specifically, when children had higher impulsivity, mothers had the highest weight. When children had average or lower impulsivity, mother weight was higher with higher endorsement of unhealthy eating behaviors. CONCLUSIONS: Findings suggest that after adjusting for the interdependent nature of temperament traits and weight, child impulsivity is an important factor associated with current weight for both mothers and children. Results also provide important implications for the impact children can have on their mothers.

Motivation for dietary restraint, and disordered eating among adults experiencing food insecurity in the United States.

OBJECTIVE: Does engaging in dietary restraint due to weight/shape concerns versus economic hardship differentially relate to disordered eating? METHOD: The sample consisted of 582 adults experiencing food insecurity (FI) who completed online measures assessing severity of FI, disordered eating, loss of control over eating, and dietary restraint. Participants reported their motivation for dietary restraint with options consisting of weight/shape concerns, economic hardship (i.e., insufficient funds and prioritizing others' needs), mixed reasons, and other/I do not know. RESULTS: In the sample, 18% reported engaging in dietary restraint primarily due to weight/shape concerns, 33% due to economic hardship, 18% other/do not know, and 30% due to a mix of reasons. There were positive correlations between FI, economic hardship, dietary restraint, disordered eating, and loss of control over eating. Regression analyses revealed the association between dietary restraint and disordered eating does not differ across individuals who endorse economic hardship as a motivator for dietary restraint. Findings replicated with loss of control. However, the association between dietary restraint and disordered eating grew stronger as more dietary restraint due to weight/shape concerns was endorsed. No significant association emerged with loss of control. DISCUSSION: Research is needed to replicate findings and examine how patterns of food scarcity impacts disordered eating in food insecure populations with and without weight/shape concerns. Findings suggest that motivation for dietary restraint may influence associations with dietary restraint and the cognitive components of disordered eating, but not the behavioral components of disordered eating. PUBLIC SIGNIFICANCE STATEMENT: Disordered eating due to dietary restraint is most commonly associated with weight and shape concerns; however, even when dietary restraint is due to economic reasons, it can still be associated with disordered eating.

Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample.

OBJECTIVE: There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782). METHOD: We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option. RESULTS: Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections. DISCUSSION: This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups. PUBLIC SIGNIFICANCE: We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.

The validation of a Farsi version of the Clinical Impairment Assessment (F-CIA) among Iranian adolescent boys and girls.

PURPOSE: Although some studies have been conducted to examine general psychosocial impairment in Iran, there is no research to date on clinical impairment secondary to disordered eating in Iranian adolescents. The purpose of this study was to evaluate the Farsi version of the Clinical Impairment Assessment (F-CIA) among Iranian adolescents. METHODS: A total of 1112 adolescents (ageM [SD] = 15.55 [1.59], body mass index [zBMI] M [SD] = - 0.00 [1.0]; 54.6% girls) were recruited from four cities (Tehran [Capital], Tabriz [North-Western], Kurdistan [West], and Rasht [North]) in Iran. After translation and back-translation procedures, the F-CIA, Eating Disorder Examination Questionnaire (EDE-Q), and Beck Depression Inventory-Second Edition (BDI-II) were administered to adolescents. We used confirmatory factor analysis (CFA), measurement invariance, independent samples t tests, Pearson correlation, chi-square tests, and internal consistency to test validity and reliability. RESULTS: CFA indicated that F-CIA demonstrated good fit to the data and supported a three-factor model. The scale was invariant across gender and zBMI. The F-CIA had good internal consistency (αs = 0.76-0.93) and positive associations (rs = 0.13-0.62; p < 0.001) with zBMI, disordered eating symptoms, and binge/purge symptoms. We found no gender differences across mean scores on the F-CIA, but adolescents with higher zBMI reported higher scores on the F-CIA relative to those with lower zBMIs. Finally, adolescents scoring above CIA cutoffs reported higher zBMI, disordered eating outcomes, and depression. CONCLUSION: Findings suggested that the F-CIA is a reliable and valid measure of clinical eating disorder-related impairment in Iranian adolescents. LEVEL OF EVIDENCE: III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.

Prenatal Neighborhood Ethnocultural Context and the Mental Health of Mothers and Children in Low-Income Mexican American Families.

Socioeconomically disadvantaged neighborhoods increase the risk for poor mental health among residents, yet protective factors may operate alongside risk. This study evaluated the influence of the prenatal neighborhood ethnocultural context on child behavior problems and maternal depressive symptoms. Prenatal maternal role expectations, prenatal culture-specific stress, and postpartum depression (PPD) symptoms were evaluated as mediators. Participants included 322 low-income, Mexican American mother-child dyads. Women (Mage  = 27.8) reported on proposed mediators, maternal depressive symptoms, and child behavior problems at 4.5 years. Neighborhood Latinx concentration was obtained from census data. Higher Latinx concentration predicted fewer maternal depressive symptoms and child behavior problems, mediated through role expectations and PPD symptoms. Results suggest prenatal neighborhood context to impact later maternal and child mental health.

The association between maternal criticism and body dissatisfaction on disordered eating pathology across racial and ethnic groups.

OBJECTIVES: Limited research exists examining the association of maternal weight-, shape-, and size-related criticism with disordered eating pathology across racial and ethnic groups. METHOD: The sample consisted of 392 undergraduate females and 368 undergraduate males for a total of 760 individuals. Disordered eating pathology, body dissatisfaction, and maternal criticism were assessed in 484 White, 134 Latinx, and 142 Asian American undergraduates. Hierarchical regression, correlation, and t-test analyses were conducted for each ethnic group. RESULTS: Among all three groups, body dissatisfaction, maternal criticism, and gender were significantly associated with disordered eating pathology. In addition, disordered eating and maternal criticism were greater among female undergraduates than among male undergraduates across all groups. However, body dissatisfaction did not differ significantly between female and male undergraduates in any of the three racial and ethnic groups. Findings from this study suggest that individual body dissatisfaction and maternal criticism may be differentially linked with disordered eating pathology across racial and ethnic groups. Among Whites and Latinx, body dissatisfaction was more strongly associated with disordered eating pathology than was perceived maternal criticism. However, among Asian Americans, perceived maternal criticism was more strongly associated with disordered eating pathology than was body dissatisfaction. CONCLUSIONS: Maternal criticism was the most saliently linked with disordered eating pathology among Asian Americans. Findings from this study speak to individual and familial factors impacting disordered eating across racial and ethnic groups. Additionally, this study highlights the potential role of culture on disordered eating, particularly self-construal and collectivistic and individualistic orientations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Overall Mental Health and Misuse of Erectile Dysfunction Medication Among Sexual Minority Men.

Background: Research has noted that rates of recreational use of erectile dysfunction medication (EDM) are particularly high among men who have sex with other men. Though previous research has investigated recreational EDM use in relation to substance use, its association with other general mental health symptoms and diagnoses remains unexamined. Objectives: To address the paucity of research on EDM misuse, the current study examined prevalence rates of EDM misuse among sexual minority men and its association with last 12-month and 30-day mental health symptoms and diagnoses. Method: A secondary analysis of 7,658 sexual minority undergraduate and graduate male students recruited as part of the American College of Health Association's National College Health Assessment was performed. Results: Results indicated that 2.2% of sexual minority men reported misuse of EDMs within the last 12 months. Last 12-month EDM misuse was significantly associated with a number of mental health symptoms and diagnoses in the last 12 months and last 30 days. Most notably, small to moderate effects were found for misuse of other prescribed medications, such as antidepressants, painkillers, and sedatives, and diagnosis of substance use within the last 12 months. Small effects were found for sedatives and steroid misuse in the last 30 days. Conclusion: Results suggest that worse mental health, particularly substance use, is associated with EDM misuse among sexual minority men. As such, further research in this area is needed.

Compensatory behaviors among racial and ethnic minority undergraduate women.

Limited research has examined prevalence rates of disordered eating across racial and ethnic groups. The current study aimed to assess the prevalence of compensatory behaviors across minority undergraduate women. Self-report responses (N = 3,430) on the Eating Disorder Examination Questionnaire were analyzed from 2,094 White (55.9%), 684 Hispanic/Latina (18.3%), 508 Asian (13.6%), 235 Black (6.3%), and 65 Native American/Alaskan Native (1.7%) women attending college within the United States. Racial and ethnic differences were significant across all compensatory behaviors. Most notably, Asian and Native American women engage in compensatory behaviors comparable to or more than their White peers, and Black women consistently reported the lowest prevalence rate of any behavior. Findings were compared to the existing literature, noting general trends across studies that may help inform screening, assessment, and treatment of eating pathology as well as suggest future directions for intervention science.

Measurement of self-regulation in early childhood: Relations between laboratory and performance-based measures of effortful control and executive functioning.

Effortful control (EC) and executive functioning (EF) are two focal constructs in the study of self-regulation in early childhood.Given a number of conceptual and empirical overlaps between EC and EF, this study examined the associations between commonly used laboratory and performance-based measures of EC and EF in early childhood. Children (N =247; age 4-6 years) completed the Shape Stroop, Snack Delay and Toy Delay tasks, as well as the Conner's Kiddie-Continuous erformance Task (KCPT).Partial correlations and confirmatory factor analysis (CFA) were conducted to assess the relations between performance on the EC and F tasks and the factor structure of self-regulation. Convergent and divergent validity were found amongst the performance-based measures. Inaddition, results from CFA support a one-factor model of self-regulation with "hot" EC and "cool" EF loading onto a general self-regulation factor. Study results highlight the similarities that exist between EC and EF during early childhood and the need for integrative, whole-child approaches in order to understand the neurophysiological and behavioral underpinnings of self-regulation and its development.

Body Dissatisfaction and Its Correlates in 5- to 7-Year-Old Girls: A Social Learning Experiment.

There is limited research on cognitive risk factors for eating disorders among young girls despite accumulating evidence that body dissatisfaction and thin-ideal internalization can begin to occur between 3 and 5 years of age. To improve upon the existing literature and significantly contribute to the prevention and intervention literature, the current study examined body dissatisfaction, thin-ideal internalization, and self-objectification in girls between 5 and 7 years of age. The sample consisted of 151 mother-daughter dyads with 63 five-year-olds, 39 six-year-olds, and 49 seven-year-olds. Girls were interviewed about their body dissatisfaction, thin-ideal, and self-objectification. In addition, all mothers and daughters participated in an individual and joint mirror experiment. Levels of body dissatisfaction were consistent across 5- to 7-year-olds. Thin-ideal internalization was higher among 5-year-olds than 6- and 7-year-olds. In contrast, self-objectification was higher among 6- and 7-year-olds than 5-year-old girls. Mother's body dissatisfaction significantly and positively predicted daughter's body dissatisfaction during the joint mirror experiment. Similarly, mother's body satisfaction significantly and positively predicted daughter's body satisfaction. Results from this study suggest that girls model their mothers' self-body talk. In addition, girls will change their positive or negative body responses after being exposed to their mothers' response.

The association between program credibility, expectancy, and acceptability with baseline pathology and outcome for a body acceptance prevention program.

OBJECTIVE: The current study sought to investigate whether credibility, expectancy, and acceptability of the Body Project is impacted by level of disordered eating pathology and whether perceived credibility, expectancy, and acceptability impacts treatment outcomes. METHODS: The sample included 170 undergraduate women from a large public university. Participants completed self-report questionnaires on perceived credibility, expectancy, treatment acceptability, and disordered eating measures. A random subset of 51 participants provided 3-month follow-up measurements. RESULTS: Analyses revealed that post-prevention credibility, expectancy, and treatment acceptability scores were negatively associated with baseline thin-ideal internalization, baseline weight, and shape concerns, and positively associated with baseline body satisfaction and the baseline restraint subscale of the EDEQ. Perceived credibility, expectancy, and treatment acceptability were not associated with session attendance or 3-month follow-up disordered eating scores. DISCUSSION: The Body Project is effective at reducing disordered eating regardless of whether participants liked the program or not.

The effects of different recruitment and incentive strategies for body acceptance programs on college women.

The objective of this study-getting individuals to participate in eating disorder prevention programs-is difficult yet crucial for dissemination efforts. Little research has investigated what incentive strategies can be particularly efficacious, and even less is published on their cost-effectiveness. The following study examined two types of email advertisements and six incentive strategies in an empirically supported body acceptance program disseminated at a large university. A total of 5,978 undergraduate women received email advertisements, of which 430 signed up to participate. An additional 588 who did not participate were assessed. Results suggest the most effective incentives were offering gift certificates for free manicure services and free personal fashion style training gift certificates from a student organization. Undergraduate women were least likely to attend due to lack of knowledge about the program, not having a friend to attend with them, or inconvenient times. Implications for future research are explored.

The relationship between acculturative stress and eating disorder symptoms: is it unique from general life stress?

The purpose of the current study was to expand upon the literature examining the relationship between acculturative stress and eating disorder symptoms among different ethnic groups. Specifically, acculturative stress was explored as a moderator of the relationship between body dissatisfaction and eating disorder symptoms among ethnic minority women. Additionally, the distinction between acculturative stress and general life stress in predicting eating disorder symptoms was assessed. Participants consisted of 247 undergraduate women, all of whom were members of an ethnic minority group including African Americans, Asian Americans, and Latinas. Acculturative stress was found to moderate the relationship between body dissatisfaction and eating disorder symptoms, but only among African American women. Acculturative stress was also found to significantly predict bulimic symptoms above and beyond general life stress among African American, Asian American, and Latina women.

Controlling parental feeding practices and child body composition in ethnically and economically diverse preschool children.

Controlling parental feeding practices may be associated with childhood overweight, because coercive or intrusive feeding practices may negatively impact children's development of self-regulation of eating. This study examined pressuring or forcing a child (healthy or unhealthy foods) and restricting child from unhealthy or snack foods as two types of controlling feeding practices that explain unique variances in measures of child body composition (BMI, percent body fat, and parental perception of child weight). In an ethnically and economically diverse sample of 243 children aged 4-6years old and their biological parents (89% biological mothers, 8% biological fathers, and 3% step or grand-parent), descriptive statistics indicate ethnic and family income differences in measures of feeding practices and child body composition. Additionally, the two "objective" indices of body composition (BMI and percent body fat) were related to low pressure to eat, whereas the "subjective" index (perceived child weight) was related to restriction. Regression analyses accounting for ethnic and family income influences indicate that pressure to eat and restriction both explained unique variances in the two "objective" indices of body composition, whereas only restriction explained variance in perceived child weight. Findings have implications for helping parents learn about feeding practices that promote children's self-regulation of eating that simultaneously serves as an obesity prevention strategy.

Examining Teacher Concerns and Anxiety on the Implementation of a Universal Body Image Program.

In the past 30 years, there have been numerous positive body image and eating disorder prevention programs targeting youth developed for school-based settings. Frequently, teachers are used as interventionists to increase dissemination, decrease costs relative to researchers, and increase scalability. However, little is known about teacher concerns and barriers that may hinder successful uptake and implementation. The current study recruited a total of 269 teachers who consented to implement a universal body image and appearance-related bullying and teasing prevention program in their classrooms as part of a randomized controlled trial. Teachers expressed some worry that they may say the wrong thing, and concern about feeling uncomfortable teaching the program due to their own body dissatisfaction. Teacher's ethnicity, gender, years teaching, dieting behaviors and other weight control behaviors, and self-efficacy were not associated with concerns related to teaching the curriculum. Teachers with lower body esteem reported higher concerns and anxiety related to teaching a body image curriculum. In free response items, teachers worried about handling student comments that were beyond the scope of the curriculum. Teacher self-efficacy was the only variable associated with the number of program sessions implemented. Findings suggest avenues to increase implementation.

Discrimination and Depressive Symptoms Among Mexican American Women: Exploring Multilevel Sociocultural Moderators.

Relative to empirical studies on risk factors, less research has focused on culturally based protective factors that reduce the impact of discrimination on mental health. The current prospective study evaluated two potential moderators of the effect of discrimination on depressive symptoms among Mexican American women: individually held familism values and neighborhood cultural cohesion. Mexican-origin women in the United States (N = 322; mean age = 27.8 years; 86% born in Mexico) reported on frequency of discrimination, depressive symptoms, familism, and neighborhood cultural cohesion. Independent models evaluated familism and neighborhood cultural cohesion as moderators of the effect of discrimination on subsequent depressive symptoms. More frequent discrimination predicted higher subsequent depressive symptoms. High familism buffered the harmful effect of discrimination on depressive symptoms, such that more frequent discrimination was associated with higher subsequent depressive symptoms only for women who reported average and low familism. Neighborhood cultural cohesion did not buffer the effect of discrimination on depressive symptoms.

Multilevel prenatal socioeconomic predictors of Mexican American children's cardiometabolic health in preschool and school age.

OBJECTIVE: Using a life course perspective, this longitudinal study examines the extent to which prenatal family- and neighborhood-level socioeconomic factors influence the cardiometabolic health of low-income Mexican American children. It was hypothesized that prenatal maternal residence in a more economically disadvantaged neighborhood and more family-level economic hardship would each be associated with higher adiposity and blood pressure (BP) at child age 4.5 years, and higher adiposity, BP, inflammation and a less healthy lipid profile at child age 7.5 years. METHOD: The sample consisted of 322 low-income, Mexican American mother-child dyads, 181 of whom completed the 7.5-year laboratory visit. Using maternal prenatal residence and U.S. census data, neighborhood concentrated disadvantage index was computed. RESULTS: Higher prenatal neighborhood concentrated disadvantage predicted higher 4.5-year adiposity in children, which, in turn, predicted higher adiposity, BP, and inflammation, and less healthy lipid profile (higher triglycerides, lower high-density lipoprotein cholesterol) at 7.5 years. Higher child 4.5-year BP was concurrently associated with higher adiposity and predicted higher 7.5-year BP. CONCLUSIONS: Extending previous work with this sample, the current study found associations between cardiometabolic risk indicators as early as preschool among Mexican American children. Furthermore, this study builds on existing literature by expanding our understanding of the effect of prenatal neighborhood concentrated disadvantage on cardiometabolic phenotypes during early childhood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).