Reciprocal longitudinal associations between positive body image and wellbeing among early-adult women.

This longitudinal study examined the prospective associations between body appreciation and wellbeing (i.e., self-esteem, depression, and emotional wellbeing) as well as body image flexibility and wellbeing among 490 women between 18-35 years of age (M = 28.63; SD = 4.27) residing in the United States. Women were contacted in three waves, each two months apart, and completed measures relating to each construct online. As a prerequisite of longitudinal analyses, this study found evidence of configural, metric, scalar, and strict invariance over time for each relevant measure. Cross-lagged panel modeling evidenced bidirectional associations between body appreciation and self-esteem between all waves and unidirectional associations between body appreciation and subsequent depression (negative) and body appreciation and subsequent emotional wellbeing (positive). Results showed bidirectional associations between body image flexibility, self-esteem, depression, and emotional wellbeing, although these bidirectional associations never occurred during the same interval between waves. This study evidences that higher body appreciation and body image flexibility are prospectively associated with increases in self-esteem, emotional wellbeing and decreases in depression, and also shows scenarios where the inverse associations also hold true. We also describe how this study complements existing cross-sectional research and the need to examine associations among more diverse participant groups.

Exploring the moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating in Chinese adolescents.

OBJECTIVES: Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents. METHOD: We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS. RESULTS: In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect. DISCUSSION: Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.

The distinct affect regulation functions of body image flexibility and inflexibility: A prospective study in adolescents and emerging adults.

Body image flexibility and inflexibility are alternative ways of responding to body image threats. Affect regulation offers a framework for understanding how these responses impact health outcomes; however, research in young people is limited. This prospective study tested two potential affect regulation functions in adolescents and emerging adults (N = 351, 66.7% female) via online surveys completed five months apart. Specifically, body image flexibility and inflexibility were tested as (a) direct predictors of adaptive (body appreciation, intuitive eating) and maladaptive (muscle-building strategies, disordered eating) outcomes, and (b) moderators of the indirect effect of a social comparison threat via body appreciation. Results from hierarchical linear and conditional process models showed that body image flexibility and inflexibility served distinct affect regulation functions. Whereas body image inflexibility directly predicted adaptive and maladaptive body- and eating-related outcomes, body image flexibility protected against the negative effects of social comparison on intuitive eating via body appreciation. Findings suggest that adolescents and emerging adults could benefit from learning body image flexibility skills and reducing inflexibility to promote positive body image and prevent body- and eating-related disturbances. Future research should investigate how body image flexibility and inflexibility relate to other established threats and outcomes in diverse demographic groups.

Explaining the prospective paths from body appreciation to intuitive eating facets: Does body image flexibility serve as a mediator?

Initial evidence suggests that body appreciation prospectively predicts intuitive eating. However, the limited number of longitudinal studies focused solely on girls and women, with a lack of evaluation among men. Furthermore, the underlying mechanisms explaining this relationship remain poorly understood. The present study examined whether body appreciation prospectively predicted intuitive eating facets among women and men in Germany. We also tested whether adaptive affect regulation skills (i.e., body image flexibility) mediated these relationships. We analyzed data from 1436 women and 704 men across three time points: Baseline (T1), 6-month (T2), and 12-month (T3) follow-up, using latent variable path models to assess direct and indirect effects. Among women, T1 body appreciation directly predicted T3 body-food choice congruence. Additionally, body appreciation indirectly predicted unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety cues at T3 via its effect on T2 body image flexibility. Among men, T1 body appreciation indirectly predicted T3 eating for physical rather than emotional reasons via T2 body image flexibility. Our findings suggest that body image flexibility plays a pivotal role in explaining why individuals who appreciate their bodies are more likely to eat intuitively.

Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study.

Unhealthy dietary behaviors and body dissatisfaction are becoming increasingly common among college students. Understanding the association between body image flexibility and intermittent fasting is particularly meaningful, especially for medical college students. This study aimed to investigate the association between body image flexibility and intermittent fasting among medical students. We conducted a cross-sectional study with 5138 medical college students at Jitang College of North China University of Science and Technology. Univariate and multivariate logistic regression were used to evaluate the association between body image flexibility and intermittent fasting. Subgroup analysis and interaction tests were further used to examine the possible interaction between body image flexibility and intermittent fasting. In this study, 1329 (25.87%) students had intermittent fasting behavior. After adjustment for confounding factors, there was a negative association between body image flexibility and intermittent fasting (OR = 0.94, 95%CI = 0.93 to 0.95, p < 0.001). A significant interaction between body image flexibility and intermittent fasting was found in gender, academic year, major, and monthly living expenses (p for interaction < 0.05). E-value analysis suggested there was unlikely to be an unmeasured confounding. This association could contribute to the establishment of personalized health intervention strategies and provide recommendations for promoting the physical and mental health of medical students.

Exploring the reciprocal associations between body appreciation, body image flexibility, and body acceptance by others in the context of the COVID-19 pandemic in Germany: Results from cross-lagged panel analyses among women and men.

The COVID-19 pandemic provided a context associated with negative consequences for body image and eating behavior. However, little is known about what factors helped to mitigate these consequences and build a positive body image. Previous research pointed to the significance of body image flexibility and perceived body acceptance by others in predicting body appreciation. However, as most of the studies have been cross-sectional, causal relationships are poorly understood. This longitudinal study tested the reciprocal association between body appreciation, body image flexibility, and perceived body acceptance by others during the COVID-19 pandemic in Germany. We analyzed data from a large community sample consisting of 1436 women and 704 men who were invited to complete the study measures (BAS-2, BI-AAQ-5, BAOS-2) at three time points, each approximately six months apart. Latent cross-lagged panel analyses revealed that greater T1 body appreciation predicted an increase in T2 body image flexibility among both genders, while for women, we additionally observed reciprocal effects between T2 and T3. Among both genders, we further found that greater body appreciation predicted increased perceived body acceptance by others over both measurement intervals (but not vice versa). Our findings are discussed in light of pandemical constraints during the studies' assessments.

A feeling difficult to identify: Alexithymia is inversely associated with positive body image in adults from the United Kingdom.

BACKGROUND: Research has increasingly examined the ways in which internal bodily experiences influence body image, including the relationship between alexithymia - the reduced ability to identify and describe one's own emotional feelings and bodily sensations - and negative body image. However, relationships between facets of alexithymia and positive body image remain unexplored. METHODS: To bridge this gap in the literature, we assessed relationships between facets of alexithymia and multiple, core indices of positive body image in an online sample of adults from the United Kingdom. A total of 395 participants (226 women, 169 men) aged 18 to 84 years completed measures of alexithymia, body appreciation, functionality appreciation, body image flexibility, body acceptance by others, and positive rational acceptance. RESULTS: Once the effects of age had been accounted for, alexithymia was significantly and negatively associated with all five body image constructs in hierarchical multiple regressions. In the final models, the alexithymia facet of Difficulties Identifying Feeling emerged as a significant and negative predictor of all indices of positive body image. LIMITATIONS: The use of cross-sectional data limits the causal conclusions that can be drawn. CONCLUSIONS: These findings extend previous work by demonstrating the unique relationship between alexithymia and positive body image, providing important implications for body image research and practice.

Understanding the role of positive body image during digital interventions for eating disorders: Secondary analyses of a randomized controlled trial.

Despite growing interest in the possible link between positive body image and eating disorder (ED) symptoms, little is known about what role this adaptive construct plays in ED treatment. This study investigated whether: (1) interventions principally designed to target ED psychopathology also lead to improvements in positive body image indices (i.e., body appreciation, functionality appreciation, and body image flexibility); (2) changes in ED symptoms correlate with changes in positive body image, both concurrently and prospectively; and (3) baseline positive body image levels moderate the degree of symptom improvement. Secondary analyses from a randomized controlled trial on digital interventions for EDs (n=600) were conducted. Intervention participants reported greater increases in the three positive body image constructs than the control group (ds=0.15-0.41). Greater pre-post reductions in ED psychopathology and binge eating were associated with greater pre-post improvements in positive body image indices. However, earlier reductions in ED psychopathology and binge eating did not predict later improvements in positive body image at follow-up. None of the positive body image constructs at baseline moderated degree of symptom change. Standard ED interventions can cultivate a more positive body image, although this is not explained by earlier symptom reduction. Understanding the mechanisms through which ED interventions enhance positive body image is needed.

Measurement invariance and psychometric properties of three positive body image measures among cisgender sexual minority and heterosexual women.

Positive body image is a multidimensional construct consisting of various facets including body appreciation, body image flexibility, and functionality appreciation measured via the Body Appreciation Scale-2 (BAS-2), Body Image-Acceptance and Action Questionnaire-5 (BI-AAQ-5), and Functionality Appreciation Scale (FAS), respectively. Research has supported the unidimensional factor structure of these measures; however, invariance testing based on sexual identity has yet to be conducted. The study's primary aim was to assess the measurement invariance of the BAS-2, BI-AAQ-5, and FAS between sexual minority and heterosexual women. The secondary aim was to assess the psychometric properties of each positive body image measure among each sample. Participants were predominantly White, cisgender women who identified as a sexual minority (n = 310) or heterosexual (n = 360) and completed online questionnaires of positive body image, eating behaviors, and mental and physical health. Results supported invariance with no differences in BAS-2 or BI-AAQ-5 scores. A significant difference with a small effect size was found in FAS scores, with sexual minority women reporting lower FAS scores. Findings supported the BI-AAQ-5 and FAS's incremental validity on perceived mental health. Overall, results suggest that the BAS-2, BI-AAQ-5, and FAS scores can be compared among women of varying sexual identities.

Body image flexibility: measurement, correlated factors and intervention / 中华行为医学与脑科学杂志

Body image flexibility (BIF) is the specific type of psychological flexibility in the research field of body image, which reflects the ability to experience negative body image and related events in an open and acceptive way, and take actions consistent with one's values. Body image is actually not stable. If negative body image could not be adjusted effectively in time, it would develop into body image disturbance (BID), which is one of the core symptoms and psychopathological mechanisms of eating disorder (ED) and body dysmorphic disorder (BDD). BIF is one of the important factors in this development path, gaining more and more attention as a protective factor for body image. So far, most studies focus on eating disorder patients and related sub-clinical populations. Body image-acceptance and action questionnaire is the most widely used measurement. BIF is related to some sample characteristics, such as gender, age and body size.Cultural context also has an impact on it.Positive and negative body image and eating disorder pathological characteristics are also strongly associated with BIF. As to the intervention, the application of mindfulness, acceptance and compassion in treatment may improve BIF. Future studies need to improve the research methods and designs, and pay attention to other samples. More specific interventions need to be developed, of which the therapeutic mechanisms also need to be explored.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress.

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n =1,068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test-retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

Body image flexibility and its correlates: A meta-analysis.

Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= -.45 to -.67), and the general psychopathology cluster (rs= -.37 to -.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 - .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.

Appearance Comparisons and Eating Pathology: A Moderated Serial Mediation Analysis Exploring Body Image Flexibility and Body Appreciation as Mediators and Self-Compassion as Moderator.

Comparing one's body against the bodies of others is related to lower positive body image and higher eating pathology. Underlying mechanisms as well as protective factors of these relationships are yet to be discovered. The present study examined body image flexibility and body appreciation as potential mediators of the association between appearance comparisons and eating disorder psychopathology. Additionally, it was tested whether self-compassion moderates the mediation effects. In an online sample comprising 250 women (Mage = 42.66, SD = 12.24), the inverse relationship between appearance comparisons and body appreciation was mediated by body image flexibility and the positive relationship between appearance comparisons and eating disorder psychopathology was mediated by body image flexibility and serially mediated by body image flexibility and body appreciation, when controlling for body mass index and age. Simple mediations were further moderated by self-compassion, such that indirect effects were attenuated at high levels of self-compassion. Promoting body image flexibility may be one potential target for helping women to engage in less maladaptive and more adaptive ways of treating the body when comparing one's appearance. Building self-compassion may be another potential target that may protect body image flexibility and its correlates in the face of appearance comparisons.

Relative associations of body image avoidance constructs with eating disorder pathology in a large college student sample.

Models of eating disorder development point to the significant role body image avoidance plays in the development and perpetuation of eating disorder pathology (EDP), highlighting the importance of continued conceptual development. For example, approaches to assessing and conceptualizing body image avoidance vary in the extent to which they emphasize topography (i.e., common forms of avoidance), or their function (i.e., the conditions under which they occur). This study considered four body image avoidance constructs and their relative incremental contribution to predicting concurrent EDP in a college student population (N = 1228). Participants self-reported both the form and function of body image avoidance, including specific behaviors, appearance fixing and avoidant coping, and body image flexibility. A measure of the form of body image avoidance emerged as the best predictor of EDP, both in terms of consistently predicting aspects of disordered eating and in terms of accounting for the largest proportions of unique variance. Body image flexibility also contributed significantly to the prediction of cognitive and emotional aspects of concurrent EDP above and beyond self-report of common forms of avoidance only. Both form and function may be important when assessing and intervening on body image avoidance to prevent EDP.

Trait body image flexibility as a predictor of body image states in everyday life of young Australian women.

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons, drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.

The effectiveness of interventions aiming to promote positive body image in adults: A systematic review.

Theory suggests promoting positive body image (PBI) through interventions would have a significant impact on health and well-being. However, little is known about the effectiveness of existing interventions. This review aimed to identify and assess the evidence of effectiveness of interventions to increase PBI in adults. Database searches were conducted using CINAHL Plus, Medline, PsychINFO, Wiley Online Library, and SCOPUS. Application of inclusion criteria and data extraction were conducted by two reviewers. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and narrative synthesis was conducted. Fifteen studies, evaluating 13 interventions, were included. Three studies, evaluating one online writing-based functionality intervention, were judged to have strong methodological quality and had evidence of improving body appreciation, body esteem, and functionality satisfaction. Six moderate quality studies found interventions using intuitive eating, CBT, self-compassion, and exercise improved PBI. There was limited evidence of effectiveness of interventions for men, suggesting future research is needed to better understand PBI mechanisms in men. Lack of heterogeneity of outcome measures is discussed as a limitation. Findings suggest existing interventions are effective at increasing aspects of PBI among women and support the development of interventions that target multiple components of PBI.

Examining sexual racism and body dissatisfaction among men of color who have sex with men: The moderating role of body image inflexibility.

Body image research with men who have sex with men (MSM) has largely focused on White MSM. The current study aimed to investigate whether men of color who have sex with men (MCSM) report similar levels of body dissatisfaction as White MSM. We also studied whether (a) the experience of sexual racism, a unique stressor for MCSM, is related to body dissatisfaction and (b) body image inflexibility moderates the relationship between sexual racism and muscularity-oriented behaviors. White MSM and MCSM (total N = 887) recruited through Amazon Mechanical Turk completed questionnaires assessing body dissatisfaction, body image flexibility, and experienced sexual racism on Qualtrics. We found that MCSM report more engagement in behaviors aimed at changing their bodies than White MSM. Additionally, experiencing sexual racism was related to higher body dissatisfaction and body image inflexibility in MCSM. In addition, body image inflexibility moderated by strengthening the association between experiencing sexual racism and muscularity-oriented behaviors. The present study highlights the need for further research with this understudied population, including intervention studies on mitigating the impact of experiencing sexual racism by increasing psychological and body image flexibility and studies aimed at reducing the incidence of sexual racism.

A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018).

The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.

Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial.

OBJECTIVE: The aim of this research was to examine the effectiveness of the acceptance and commitment therapy (ACT) for body image flexibility and body awareness in these patients. METHODS: A randomized clinical trial was conducted at Kashan University of Medical Sciences clinics in Kashan, Iran, from December 1, 2017 to March 30, 2018. A sample of 75 patients with psychosomatic disorders was selected by convenience sampling. The selected patients were randomly divided into three 25-member groups. The experimental group received medicinal treatment combined with the (ACT). The active control group received the usual treatment plus psycho education in general psychology, and the treatment group solely received the medicinal treatment usually used in the treatment centers. The results were obtained using the following scales in the pretest and posttest phases and the two-month follow-up: the demographic questionnaire; Shields' body awareness questionnaire; and Sandoz's body image flexibility questionnaire. The data were analyzed using the descriptive statistics tests (mean and standard deviation) and the repeated measures analysis of variance and chi-square tests in IBM-SPSS version 21. RESULTS: There was no significant difference among the three groups in terms of body image flexibility, body awareness, somatic symptoms, and demographic variables. The results of the posttest and follow-up examinations suggested that the ACT group more effectively and significantly improved body image flexibility and body awareness as compared to both of the control groups (p=0.02). CONCLUSIONS: The ACT successfully improves body image flexibility and body awareness in patients with psychosomatic disorders. CLINICAL TRIAL REGISTRATION: This research was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2017092532057N2. FUNDING: Research and Technology Department of Kashan University of Medical Sciences funded the study (Ref: 96053).

Understanding self-concealment within a framework of eating disorder cognitions and body image flexibility: Conceptual and applied implications.

Although self-concealment has been long recognized in the context of body image disturbance and disordered eating concerns, empirical evidence remains limited. Following cognitive behavioral therapy (CBT) models of disordered eating and body image concerns, the present cross-sectional study examined whether the construct of self-concealment was related to disordered eating and body image concerns. More specifically, we investigated whether eating disorder cognitions and body image flexibility, two factors linked to the maintenance of disordered eating concerns, are uniquely associated with self-concealment, while controlling for key demographic and sociocultural variables. Three-hundred thirty-six undergraduate women completed a web-based survey that included measures of interest. Results revealed that eating disorder cognitions associated with the fear of weight gain and body image flexibility were uniquely related to self-concealment in expected directions.