"Can you see me?" Videoconferencing and eating disorder risk during COVID-19: Anxiety, impairment, and mediators.

OBJECTIVE: The use of videoconferencing has increased during the pandemic, creating prolonged exposure to self-image. This research aimed to investigate whether eating disorder (ED) risk was associated with videoconferencing performance for work or study and to explore whether the use of safety behaviors and self-focused attention mediated the relationship between ED risk and perceived control over performance anxiety, impaired engagement, or avoidance of videoconferencing for work or study. METHOD: In 2020, an online survey was distributed within Australia to those aged over 18 years via academic and social networks, measuring: use of videoconferencing for work/study, demographics, ED risk, safety behaviors for appearance concerns, self-focused attention, perceived control over performance anxiety, perceived engagement impairment, and avoidance of videoconferencing. A total of 640 participants (77.3% female, Mage  = 26.2 years) returned complete data and were included in analyses. RESULTS: 245 participants (38.7%) were considered at-risk for EDs (SCOFF > 2). Those at-risk reported significantly more safety behaviors, self-focused attention, impaired engagement, and avoidance, plus lower perceived control over performance anxiety than those not at-risk. Multiple mediation models found the effects of ED risk on control over performance anxiety, impaired engagement, and avoidance were partially mediated by safety behaviors and self-focused attention. DISCUSSION: Our cross-sectional findings suggest videoconferencing for work/study-related purposes is associated with performance anxiety, impaired engagement, and avoidance among individuals at-risk for EDs. Poorer videoconferencing outcomes appear more strongly related to social anxiety variables than ED status. Clinicians and educators may need to provide extra support for those using videoconferencing. PUBLIC SIGNIFICANCE: Because videoconferencing often involves seeing your own image (via self-view) we wondered whether the appearance concerns experienced by those with eating disorders (EDs) might interfere with the ability to focus on or to contribute to work/study videoconferencing meetings. We found that although those with EDs experience more impairments in their videoconferencing engagement/contribution, these were linked just as strongly to social anxiety as they were to appearance concerns.

Mumbod? A comparison of body image and dietary restraint among women with younger, older, and no children.

Pregnancy and the postpartum period are times of significant body, and body image changes for women. Adult women (N = 885) aged 21 to 47 years old completed an online questionnaire. Mothers of young children (0-5 years) had significantly lower levels of body shame, self-objectification, and dietary restraint than women without children, and women with school-aged (6-10 years) children had significantly lower self objectification than women without children, once we controlled for age. BMI predicted body shame more than motherhood status. This research has implications for the development of appropriate body image interventions for adult women.

Do we cause harm? Understanding the impact of research with young children about their body image.

Although research into the early development of body image and eating behaviors is essential, concerns have been raised about whether their assessment might precipitate body or eating concerns in children. We aimed to identify how parents perceived their young children (under 9 years) had been impacted from involvement in the longitudinal Children's Body Image Development Study (CBIDS) that assessed body image and eating behaviors. Participants were 218 parents (99 % mothers) who completed an online questionnaire assessing whether and why their child discontinued participation in CBIDS, and the perceived impact of participation on children's body image, weight attitudes, language about bodies, internalisation of appearance ideals, peer appearance conversations, dietary restraint, muscle building activities, and physical activity. Impact and reasons for cessation of participation were assessed retrospectively. Almost all parents were positive or neutral about their child's involvement, 0.5%-3.2% of parents perceived a negative impact in an area, and 0.9 % of parents moderately agreed that they regretted participating in CBIDS. Themes for positive and negative aspects of CBIDS involvement were explored using thematic analysis. Although research is essential to guide development of prevention strategies, this study highlights the need to implement safeguards to ensure a positive experience for all children.

Maternal influences on body image and eating concerns among 7- and 8-year-old boys and girls: Cross-sectional and prospective relations.

OBJECTIVE: Little is known regarding maternal influences on the body image and eating concerns of young children. The current study aimed to examine the cross-sectional and longitudinal relationships between maternal comments about their child's weight and shape and eating, and mothers' own body dissatisfaction and disordered eating on one hand, and their children's body esteem and disordered eating behaviors on the other. METHOD: Children, n = 244 of the fifth wave, aged 7 years (58% female), and n = 194 of the sixth wave, aged 8 years (57% female), of the longitudinal Children's Body Image Development Study, in Melbourne, Australia were included. Mothers completed measures of body dissatisfaction, dietary restraint, and comments and concerns regarding their children's weight and eating behaviors. They also reported on their children's disordered eating behaviors. Children's body esteem was assessed through a child interview. RESULTS: Findings revealed cross-sectional and prospective bivariate relationships between maternal comments and disordered eating behaviors among both boys and girls. Similar patterns of relationships emerged between maternal body dissatisfaction and lower child body esteem. CONCLUSION: Findings highlight the importance of conducting prevention within the family environment from a young age, and targeting both direct communication as well as parental body image and eating behaviors.

Leading by example: Development of a maternal modelling of positive body image scale and relationships to body image attitudes.

The aims of this study were to develop a measure, the Role Modelling of Body Image (Attitudes and Behaviors) Questionnaire (RMBI-Q), to determine maternal perceptions of their body image role modelling in front of their children, and to evaluate how role modelling differs with demographic characteristics to identify characteristics of mothers who may require assistance in being a positive role model. Participants were a community-based sample of 887 mothers who provided demographic information and completed the RMBI-Q, Body Appreciation Scale (BAS-2), and a measure of dietary restraint (DEBQ) in an online questionnaire. Exploratory factor analysis revealed one 7-item factor for the RMBI-Q. Confirmatory factor analysis revealed that removal of an item was necessary for model fit, and thus, a 6-item version of the RMBI-Q was evaluated. Good internal consistency, test-retest reliability, content validity, and convergent validity were found. Higher scores on the RMBI-Q correlated with greater maternal body appreciation and lower dietary restraint. More positive role modelling was reported by mothers with lower body mass index and younger children. The RMBI-Q is useful for assessing maternal modelling of positive behaviors that may improve children's body image. Findings highlight avenues for body image interventions for mothers.

A qualitative, prospective study of children's understanding of weight gain.

This study examined 3- to 5-year-old children's understandings of increases in body size via a qualitative prospective approach. A sample of 259 children (55.2% girls) was interviewed at 3, 4, and 5 years old. Participants were shown an average and a larger size figure of a child of their gender and age. Responses to 'Why do you think the boy/girl got bigger here?' were coded using thematic analysis. Diet was cited as a mechanism for increased body size by almost 50% of children referring to this by age 5. Few children mentioned physical activity. Responses suggesting that increases in body size had negative implications increased between ages 3 and 5. Awareness of associations between diet and weight gain emerges as young as 3 years old and increases over time, as do negative attitudes about weight gain. This age may be opportune for interventions targeting sustainable healthy behaviours. Statement of contribution What is already known on this subject? Even very young children present weight bias. Their understanding of the social messages regarding weight and shape increases with age. Older children present a partial understanding of how diet and physical activity are related to body size. What does this study add? Very young children's understandings of increases in body size were investigated. Eating and food-related mechanisms, as well as ageing, were salient. By age 5, over a third of children associated increases in body size with negative implications.

Confident body, confident child: Evaluation of a universal parenting resource promoting healthy body image and eating patterns in early childhood-6- and 12-month outcomes from a randomized controlled trial.

OBJECTIVE: To evaluate Confident Body, Confident Child (CBCC), a universal parenting resource designed to promote positive body image and healthy eating patterns in children aged 2-6 years, at 6- and 12-months follow-up. METHOD: A four-arm randomized controlled trial with 345 parents was conducted. Group (A) received the CBCC resource pack + workshop, (B) received the CBCC resource pack only, (C) received a nutrition booklet and (D) received no interventions until all questionnaires were completed (i.e., waitlist control). Measures of parenting variables relevant to child body image and eating patterns, and parent-report of child weight, were administered at baseline, 6-weeks post-intervention (results reported previously), and 6- and 12-months follow-up. RESULTS: Mixed effects modeling comparing group averages over time revealed that significant group differences on measures of knowledge, parenting intentions and the parental feeding practice of weight restriction were still present at 12-months follow-up, though the remaining measures showed no significant differences between groups over time. The two CBCC groups reported more positive and less negative outcomes than the nutrition booklet active control. DISCUSSION: The CBCC program achieved sustained improvements in some parenting variables at 12-months, suggesting its value as an effective parenting intervention. Changes to the intervention design, such as the addition of a follow-up parent workshop, however, would likely increase its efficacy.

Low body esteem and dietary restraint among 7-year old children: The role of perfectionism, low self-esteem, and belief in the rewards of thinness and muscularity.

Body image concerns and dietary restraint have been shown to emerge among young children (aged 5 to 8 years). However, to date, little is known regarding the way in which individual characteristics and endorsement of sociocultural appearance ideals are associated with these concerns and behaviors in this age group. The aim of the current study was to examine perceived rewards of thinness and muscularity as a mediator of the relationships between personality traits (perfectionism and self-esteem), and body esteem and dietary restraint among 7-year-old children. Participants were 261 children, Mage (SD) = 7.46 (0.32), assessed during interview on a range of scales measuring variables of interest. Findings revealed that, with the addition of direct pathways leading to dietary restraint, the model was a good fit to the data. Furthermore, multi-group analyses revealed no gender differences. These results highlight the role of children's individual personality characteristics as well as the degree to which they uphold thin and muscular appearance ideals in body image and eating concerns in 7 year olds. Additional efforts should be made to engage this age group with prevention resources and to target personality characteristics as well as beliefs in the rewards of appearance ideals.

Psychological predictors of body image attitudes and concerns in young children.

We aimed to examine cross-sectional and longitudinal relationships between psychological characteristics, body size, and body image outcomes in 6- to 7-year-old children. Participants were 202 children (91 boys, 111 girls) assessed when 6 and 7 years old. Body image-related variables, body mass index, and psychological characteristics were assessed. Cross-sectionally in the total sample, lower self-esteem was associated with greater body dissatisfaction, internalization of appearance ideals, and rewards of muscularity. Greater perfectionism was associated with greater body dissatisfaction, dietary restraint, drive for muscularity, and rewards of thinness and muscularity. Prospectively, internalization and socially prescribed perfectionism at 6 predicted greater body dissatisfaction at 7; higher perfectionism predicted greater rewards of thinness; higher perfectionism and lower self-esteem predicted greater rewards of muscularity; and lower self-esteem and smaller perceived body size predicted higher internalization. Exploratory gender specific analyses suggest that self-esteem may play a greater role in the development of body image attitudes in girls than boys, while perfectionism appears to increase boys' vulnerability to perceive greater rewards from thinness. Findings support the inclusion of psychological characteristics in etiological models of early body image development, and highlight perfectionism, internalization of appearance ideals, and self-esteem as potential targets for preventative interventions in this age group.

Achieving body confidence for young children: Development and pilot study of a universal teacher-led body image and weight stigma program for early primary school children.

Negative body image attitudes develop in early childhood and there is a need for school-based resources during the early school years, but no teacher-delivered curriculum-based resources exist to mitigate these attitudes in young children. Achieving Body Confidence for Young Children (ABC-4-YC), a universal body dissatisfaction and weight stigma prevention program, was developed and then delivered in a pilot study. Fifty-one 5- to 8-year-old children completed pre- and post-intervention interviews assessing body image attitudes, and seven teachers provided feedback. Significant improvement in body esteem and positive teacher feedback were found. The results provide preliminary support for ABC-4-YC to improve children's body image attitudes, but extensive evaluation is needed.

Media exposure in very young girls: Prospective and cross-sectional relationships with BMIz, self-esteem and body size stereotypes.

Media exposure among young children has been suggested to influence self-concept and the adoption of social stereotypes regarding body weight, as well as being associated with increased weight. The aim of this study was to examine the role of TV/DVD viewing in the development of positive stereotypes toward thinness, self-esteem and body mass index standardized for child age and gender (BMIz) in very young girls. A sample of 143 girls completed interviews at ages 3, 4, and 5 years old. The interviews assessed positive stereotypes about thinness among girls, as well as age 5 dietary restraint. Parents reported on their daughters' self-esteem and TV/DVD viewing. Objective height and weight were obtained for the children. A cross-lagged model exploring TV/DVD viewing as a predictor of lower self-esteem, greater BMIz, and endorsement of positive stereotypes about thinness was tested, including dietary restraint as an outcome at age 5. Findings revealed partial support for the theoretical model, with relationships emerging most strongly between the ages of 4 and 5 years old. Greater TV/DVD viewing was weakly related to greater endorsement of positive stereotypes about thinness between ages 3 and 4. In addition, greater TV/DVD viewing at age 4 predicted BMIz increases at age 5, as well as greater dietary restraint. Our results suggest that the impact of media exposure on body image and weight-related variables may start at a very early age. Findings contribute to the body of literature suggesting that early childhood may be an important developmental period for media exposure. (PsycINFO Database Record

"Does the voice in your head get kinder as you get older?" Women's perceptions of body image in midlife.

This study aimed to identify attitudes and reactions toward physical changes in midlife women. A Facebook thread, presenting a series of comments related to an initial statement, instigated by a radio program was analyzed. The thread contained 87 responses to the question "Does the voice in your head get kinder as you get older?" Content analysis revealed positive (56%) and negative (40%) comments and four themes: physical changes with aging, the decreased importance of physical appearance, the importance of sociocultural influences, and the invisibility of women in midlife. Findings revealed both positive and negative body image experiences in women related to midlife and have implications for prevention.

Correlates of parental feeding practices with pre-schoolers: Parental body image and eating knowledge, attitudes, and behaviours.

Parental feeding practices have been linked to eating and weight status in young children; however, more research is needed to understand what influences these feeding practices. The aim of this study was to examine how parental feeding practices that are linked to unhealthy eating patterns in young children, are related to parental body image and eating knowledge, attitudes, and behaviours . Participants were 330 mothers of a 2- to 6-year-old child. Mothers completed measures of knowledge of child body image and eating patterns, overvaluation of weight and shape, internalization of general media and athletic ideals, dieting, and parental feeding practices. Higher maternal knowledge of strategies to promote positive child body image and eating patterns predicted lower weight restriction, instrumental, emotional, and pushing to eat feeding practices. Overvaluation of weight and shape predicted use of fat restriction. Maternal internalization of the athletic ideal predicted instrumental and pushing to eat feeding practices. As these feeding practices have been associated with long-term risk of children's weight gain and/or disordered eating, these findings highlight the need for prevention interventions to target knowledge, attitudes, and behaviours of parents of pre-schoolers.

Confident body, confident child: A randomized controlled trial evaluation of a parenting resource for promoting healthy body image and eating patterns in 2- to 6-year old children.

OBJECTIVE: Body image and eating patterns develop in early childhood and are influenced by the family environment. This research evaluated Confident Body, Confident Child (CBCC), an intervention for parents of 2- to 6-year-old children, designed to promote body satisfaction, healthy eating, and weight management in early childhood. METHOD: A randomized controlled trial compared four groups: (A) received the CBCC resource pack and a workshop, (B) received the CBCC resource pack only, (C) received a nutrition-only resource and (D) received no interventions until all questionnaires were completed (i.e., functioned as waitlist control). Measures of parenting variables relevant to child body image and eating patterns, parent-report of child weight, and evaluation questions about the resource, were implemented pre- and post-intervention. RESULTS: At 6-weeks post-intervention, the CBCC resource was associated with significant reductions in parents' intentions to use behaviors that increase the risk of negative body attitudes or unhealthy eating in their children, in parents' use of feeding practices associated with childhood overweight, and in television watching during family meals. Significant increases in parents' intentions to use positive behaviors and knowledge of child body image and healthy eating patterns were also found. Superior results were found for the CBCC resource + workshop condition, suggesting it is the preferred delivery method. DISCUSSION: CBCC positively impacts parenting variables associated with childhood risk for body dissatisfaction, unhealthy eating and weight. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:458-472).

'He's got his father's bias': Parental influence on weight bias in young children.

Our aim was to explore the role of parents in the transmission of stereotypical body size attitudes and awareness of weight loss strategies to preschool children. Participants were 279 3-year-old children and their parents, who provided data at baseline and 1 year later. Parents completed self-report body size attitude and dieting measures. Child weight bias and awareness of weight loss strategies were assessed through interview. Over time, negative associations with large bodies and awareness of weight loss strategies increased. Fathers' attitudes prospectively predicted boys' weight bias and awareness of weight loss strategies. Among girls, parental attitudes were less predictive. Findings confirm the importance of fathers in the development of boys' body attitudes and inform prevention programmes.

"Stop eating lollies and do lots of sports": a prospective qualitative study of the development of children's awareness of dietary restraint and exercise to lose weight.

BACKGROUND: Beliefs surrounding the usefulness of dietary restriction and physical activity as means of body shape and size modification is already present in children as young as 5-years-old, and these beliefs may increase the risk of unhealthy weight control behaviours later in life. To date, however, little is known regarding the development of these beliefs in younger children. The aim of the present study was, therefore, to explore young (aged 3- to 5-years old) children's conceptualisations of dietary restriction and physical activity as means to change body size using a prospective approach. METHODS: A sample of 259 children (116 boys, 143 girls) participated in interviews at 3-, 4- and 5-years-old. Participants were shown silhouette figures of a child of their gender and age. Their responses to questions regarding how the figure could return to a previous thinner shape were qualitatively coded using thematic analysis. RESULTS: Children's responses revealed that while, for a subsample, modifications of food, eating, and exercise patterns were the most salient ideas, a number of other mechanisms of body change were also suggested. Responses also evidenced adoption or awareness of stigmatising attitudes towards overweight individuals (over 15% by age 5). The proportion of children demonstrating an awareness of dietary restriction and physical exercise as methods for body size change increased significantly at each time point. While only 4.2% demonstrated dieting awareness at 3-years-old, this proportion had risen to almost 28% by 5-years-old (p < .001). Similarly, the proportion of children aware of exercise as a body change strategy rose from 2.3 to 16.3% (p < .001), with 22% of 5-year-olds mentioning general physical activity as a strategy. No gender differences were found. CONCLUSIONS: Awareness of dietary restriction and physical exercise as strategies for weight loss and body change emerges as young as 3-years-old, and significantly increases from 3- to 5-years-old. Interventions aiming to promote healthy means of weight control and obesity prevention should consider that certain attitudes may already be present in very young children.

Dietary restraint of 5-year-old girls: Associations with internalization of the thin ideal and maternal, media, and peer influences.

OBJECTIVE: Understanding socio-cultural factors associated with the development of dieting tendencies is important for preventing future disordered eating. We explored individual and socio-cultural factors associated with weight-focussed dietary restraint tendencies (described as dietary restraint) in 5-year-old girls. METHOD: Participants were 111 5-year-old girls and 109 of their mothers. Girls were interviewed about their dietary restraint, body image, appearance ideals, positive weight bias (attributing positive characteristics to thinner figures), and peer conversations. Mothers completed self-report questionnaires assessing dietary restraint and appearance ideals, as well as measures reporting on their daughter's media exposure and peer appearance interest. RESULTS: Thirty-four percent of girls reported at least a moderate level of dietary restraint. While most girls were satisfied with their body size, half showed some internalization of the thin ideal. Girls' dietary restraint was correlated with weight bias favoring thinner bodies, and greater internalization of the thin ideal, media exposure, and appearance conversations with peers. Media exposure and appearance conversations were the strongest predictors of dietary restraint. DISCUSSION: These cross-sectional findings suggest that the socio-cultural environment of young girls may be important in the very early development of unhealthy dieting tendencies. Longitudinal research is necessary to identify whether these are prospective risk factors.

What parents know and want to learn about healthy eating and body image in preschool children: a triangulated qualitative study with parents and Early Childhood Professionals.

BACKGROUND: Interventions for parents to encourage healthy eating in children often do not address parental feeding practices and body image development. METHODS: The current study investigated what parents (of children aged 1-6 years) understand about child healthy eating and body image, and what they would like in future interventions, by using structured focus groups with parents, and individual interviews with Early Childhood Professionals. Forty three parents (M(age) = 36.95 years, 93% female, 79% university degree) participated across 9 focus groups. Eleven Early Childhood Professionals (M(age) = 51.04, 100% female, 64% university degree, 64% Maternal and Child Health Nurses, 36% Childcare Centre Directors) completed individual telephone interviews. RESULTS: Parents described healthy eating as a variety, balance, and range of foods as well as limiting certain foods, such as the intake of sugar, salt, and processed foods. Most often parents defined child body image as a child's physical appearance and did not mention thoughts and feelings related to appearance or body experiences. Body image was most commonly considered a problem in early adolescence and often not an issue of relevance in early childhood. Parents appeared knowledgeable about nutrition and accessed information about healthy eating across a range of resources though rarely accessed information about child body image. They desired more practical information about how to avoid encouraging negative body image when promoting healthy eating. Professionals' responses confirmed these findings. CONCLUSIONS: Results suggest future interventions need to stress the important role positive body image plays in encouraging healthy attitudes to food and weight management, and the benefits positive body image can have on the health and mental health of preschool children.

Relationships between body size attitudes and body image of 4-year-old boys and girls, and attitudes of their fathers and mothers.

BACKGROUND: Body size attitudes and body image form early in life, and understanding the factors that may be related to the development of such attitudes is important to design effective body dissatisfaction and disordered eating prevention interventions. This study explored how fathers' and mothers' body size attitudes, body dissatisfaction, and dietary restraint are associated with the body size attitudes and body image of their 4-year-old sons and daughters. METHODS: Participants were 279 4-year-old children (46% boys) and their parents. Children were interviewed and parents completed questionnaires assessing their body size attitudes and related behaviours. RESULTS: Socially prescribed stereotypical body size attitudes were evident in 4-year-old boys and girls; however, prevalence of body dissatisfaction was low in this sample. Correlation analyses revealed that boys' body size attitudes were associated with a number of paternal body image variables. In boys, attributing negative characteristics to larger figures and positive characteristics to thinner figures were associated with fathers having more negative attitudes towards obese persons. Attributing positive characteristics to larger figures by boys was associated with greater levels of paternal dietary restraint. In girls, attributing positive characteristics to thinner figures was only associated with greater maternal dietary restraint. CONCLUSIONS: Findings suggest the possibility that fathers' body size attitudes may be particularly important in establishing body size attitudes in their sons. Further research is necessary to better understand the role of fathers in the development of children's body size attitudes.

Development and validation of parenting measures for body image and eating patterns in childhood.

BACKGROUND: Evidence-based parenting interventions are important in assisting parents to help their children develop healthy body image and eating patterns. To adequately assess the impact of parenting interventions, valid parent measures are required. The aim of this study was to develop and assess the validity and reliability of two new parent measures, the Parenting Intentions for Body image and Eating patterns in Childhood (Parenting Intentions BEC) and the Knowledge Test for Body image and Eating patterns in Childhood (Knowledge Test BEC). METHODS: Participants were 27 professionals working in research or clinical treatment of body dissatisfaction or eating disorders, and 75 parents of children aged 2-6 years, who completed the measures via an online questionnaire. Seven scenarios were developed for the Parenting Intentions BEC to describe common experiences about the body and food that parents might need to respond to in front of their child. Parents ranked four behavioural intentions, derived from the current literature on parenting risk factors for body dissatisfaction and unhealthy eating patterns in children. Two subscales were created, one representing positive behavioural intentions, the other negative behavioural intentions. After piloting a larger pool of items, 13 statements were used to construct the Knowledge Test BEC. These were designed to be factual statements about the influence of parent language, media, family meals, healthy eating, and self-esteem on child eating and body image. The validity of both measures was tested by comparing parent and professional scores, and reliability was assessed by comparing parent scores over two testing occasions. RESULTS: Compared with parents, professionals reported significantly higher scores on the Positive Intentions subscale and significantly lower on the Negative Intentions subscale of the Parenting Intentions BEC; confirming the discriminant validity of six out of the seven scenarios. Test-retest reliability was also confirmed as parent scores on the two Parenting Intentions subscales did not differ over time. Eleven out of the 13 Knowledge Test items demonstrated sufficient discriminant validity and test-retest reliability. CONCLUSIONS: Overall, results indicated that the six-scenario Parenting Intentions BEC and the 11-item Knowledge Test BEC are valid and reliable measures for parents of young children.