Relation between orthorexia nervosa and healthy orthorexia: A latent profile analysis.

Orthorexic eating behaviors can be conceptualized as a bidimensional construct encompassing an orthorexia nervosa dimension (ON) and a healthy orthorexia dimension (HO). Although variable-centered studies showed that ON and HO are distinguishable orthorexic eating behaviors, the evidence of whether they can co-occur or be distinct in subgroups of individuals is still limited. The present study aimed to address previous person-centered studies' limitations by examining profiles of ON and HO among a convenience sample of 251 French-speaking Canadian adults (85.7% women; Mage = 33.56). Profile membership was examined as function of participants characteristics such as age, gender, body mass index, frequency of physical activity and sports and vegetarianism. The relation between profile membership, intuitive eating and disordered eating attitudes and behaviors was also assessed. Latent profile analysis (LPA) were used to estimate profiles of ON and HO. Results from LPA did not provide support for the distinguishability of ON and HO. Indeed, they revealed the presence of two profiles showing co-occurring levels of ON and HO that only differed quantitatively: low (68.9% of the sample; low levels of ON and HO) or moderate orthorexic eating behaviors (31.1%; moderate levels of ON and HO). Participants who declared being vegetarian and being more frequently involved in physical activities and sports were more likely to belong to the moderate orthorexic eating behaviors' profile. Finally, participants from the moderate orthorexic eating behaviors' profile showed higher levels of disordered eating attitudes and behaviors, whereas those from the low orthorexic eating behaviors' profile showed higher levels of intuitive eating. Findings from the present study question the distinguishability of ON and HO dimensions. They also suggest that, similarly to ON, HO is also related to higher eating and lifestyle preoccupations.

Profiles of body image concerns and their associations with disordered eating behaviors.

Although body image concerns (BIC) are recognized as a core driver in the development of disordered eating behaviors, the combined role of various types of BIC remains underexamined. This study relied on latent profile analysis to identify the main configurations of self-reported BIC (i.e., body checking and avoidance, perceived physical appearance, and fear of negative appearance evaluation) observed in a sample of 419 French-Canadian individuals (Mage = 26.59, SDage = 9.23). The role of body mass index, sex, and age on profile membership was also examined, as well as the relation between profile membership and disordered eating behaviors (i.e., dieting, bulimia and food preoccupation, and oral control). Six distinct BIC profiles differing in terms of shape and level were identified, with women being more likely to display a profile characterized by higher levels of BIC. In turn, profiles characterized by higher levels of BIC were associated with more disordered eating behaviors. The present study can broaden our understanding of the onset and maintenance of disordered eating behaviors and inspire the development of more tailored body-image interventions.

Validation of a Virtual Environment to Induce State Social Physique Anxiety in Women with Obesity and Social Physique Anxiety.

State Social Physique Anxiety (SPA), in contrast to Trait SPA, is triggered by specific situations that elicit SPA. To date, no research has used virtual reality (VR) to recreate a situation that may elicit State SPA. The purpose of this study is to validate a virtual environment (VE) that simulates an anxiogenic situation to induce State SPA in women with obesity and high SPA. The high SPA group consisted of 25 self-identified women living with obesity and high Trait SPA. The low SPA group consisted of 20 self-identified women with low SPA. All participants were immersed in a virtual swimming pool environment for 10 min using a virtual reality headset. After the immersion, State SPA and fear of being negatively judged felt during immersion were measured with self-report questionnaires. A questionnaire assessing unwanted negative side effects was administered before and after the immersion. Using an ANCOVA with Trait SPA as covariate, State SPA was found to be significantly higher in the high SPA group. Fear of being judged negatively was also significantly higher in the high SPA group. Unwanted negative side effects scores did not increase post-immersion in either group. This study documents the validity of a novel VE for inducing State SPA in women with obesity and high SPA.

Body image interventions within breast cancer care: A systematic review and concept analysis.

There needs to be a consensus regarding the definition of body image in oncology the literature. This lack of agreement leads to conflicting results in psychosocial interventions aimed to improve body image among breast cancer patients. Through an instrumentalist approach, this systematic review aims to analyze how body image as a concept is described and operationalized in breast cancer studies with the focus to enhance body image through psychosocial interventions. Databases were searched in October 2022 and updated in February 2023 to find empirical studies reporting psychosocial intervention targeting body image efficacy. The results from 24 studies show many similarities and differences between the definitions (e.g. characteristics) and questionnaires (e.g. Cronbach's alpha coefficient) used to evaluate this concept. Most definitions include thoughts, feelings, and behaviors related to body image. Finally, the psychosocial implications are discussed. This systematic review is registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022326393).

Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age.

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

Factors Associated with Excess Skin After Bariatric Surgery: a Mixed-Method Study.

PURPOSE: After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences. MATERIALS AND METHODS: A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage 46.5 ± 9.9 years, Mtime post-MBS 34.2 ± 27.6 months). During phase I, ES quantity (arms, abdomen, thighs) and inconveniences and sociodemographic, anthropometric, clinical, and behavioral outcomes were assessed. In phase II, 7 focus groups were performed with 37 participants from phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data. RESULTS: Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r = .36, p < .01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r = .48, p < .05) and current BMI (r = .35, p < .05). Greater ES inconvenience was associated with higher social physique anxiety and age (R2 = .50, p < .01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes. CONCLUSION: Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.

A survey of eating styles in eight countries: Examining restrained, emotional, intuitive eating and their correlates.

INTRODUCTION: Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample. METHOD: Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey. RESULTS: Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries. CONCLUSION: Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.

Psychometric properties of the Teruel Orthorexia Scale (TOS) among a French-Canadian adult sample.

BACKGROUND: Psychometric properties of the Teruel Orthorexia Scale (TOS) have been examined in several languages (Arabic, English, Portuguese, Spanish, and Turkish), but not in French. PURPOSE: The objective was to examine the psychometric properties of the TOS among a French-Canadian adult sample. METHODS: Participants were 296 French-speaking Canadian adults (M = 34.2 years, SD = 11.9, 85.1% women). They completed the TOS alongside with several other measures (e.g., alcoholic consumption, cigarette smoking, disturbed eating attitudes and behaviors, frequency of physical activities, intuitive eating, vegetarian diet, and negative affect). RESULTS: The results supported the a priori two-factor representation (orthorexia nervosa and healthy orthorexia) of the French version of the TOS and provided further support for the superiority of an exploratory structural equation modeling approach, relative to a confirmatory factor analytic approach. Furthermore, the results supported no differential item functioning as a function of respondents' characteristics (age, body mass index, diagnosis of eating disorders, frequency of physical activities, gender, and vegetarian diet). Latent mean differences were found in healthy orthorexia and orthorexia nervosa factors as a function of respondents' characteristics. Finally, significant correlations were found between TOS factors and convergent measures (alcohol consumption, cigarette smoking, disturbed eating attitudes and behaviors, intuitive eating, and negative affect). CONCLUSION: The present study confirmed that the French version of the TOS has satisfactory psychometric properties (i.e., factor validity and reliability, no differential item functioning, and convergent validity). LEVEL OF EVIDENCE: V, cross-sectional study.

Testing of a model for risk factors for eating disorders and higher weight among emerging adults: Baseline evaluation.

Although a range of risk factors have been identified for disordered eating and weight status, the breadth of risk factors have been rarely considered within a single, comprehensive model. The robustness of these findings across countries also remains an open question. The present study sampled 6272 participants aged 18-30 years from eight countries in an attempt to evaluate combined and unique predictors for these two conditions, and to explore possible cross-country differences in these models. Participants completed a range of demographic, biological, behavioral, psychological, and sociocultural measures to test a comprehensive model of the contributions of these predictors for disordered eating and weight-related constructs (binge eating, body mass index, compensatory behaviors, dietary restraint, drive for muscularity, and drive for leanness). Structural invariance testing within a multigroup path analysis framework revealed that a single model across the eight countries provided poor model fit. Freeing of 22% of parameters across countries provided excellent fit and a satisfactory compromise for country-invariant and country-variant parameters in the model. Overall, predictors accounted for between 15% and 60% of variance in the outcome measures, with lowest explained variance for the disordered eating outcomes. Significant unique contributions to prediction were observed for each of the five risk factor variable types and across the eight countries. Thus, the findings show strong support for this model as an explanatory framework of both disordered eating and weight status.

Psychometric Properties of a French Version of the Perceived Motor Competence in Childhood Questionnaire.

In this study, we examined the psychometric properties of a French version of the Perceived Motor Competence in Childhood (PMC-C) questionnaire. The participants were 219 French-speaking children (aged 5-12 years), recruited from elementary schools in the Canadian Province of Quebec. Results supported the validity and reliability of a second-order confirmatory factor analytic (CFA) model, including one higher-order factor. Additional analyses supported the complete measurement invariance of the first- and second-order factor structure across sex and indicated no differential item functioning or latent mean differences in PMC-C factors as a function of selected predictors (i.e., age, body mass-index and physical activity/sport involvement). Thus, this French version of the PMC-C has satisfactory psychometric properties (i.e., factor validity and reliability, measurement invariance and differential item functioning) and can be used to assess French-speaking children's perceived motor competence.

The children's eating attitudes test: French validation of a short version.

PURPOSE: Disordered eating attitudes and behaviors (DEAB) in childhood have been prospectively associated with eating disorders and obesity in adolescence. Therefore, evaluating DEAB in children with a reliable, sensitive and well-adapted scale is very important. The Children's Eating Attitudes Test (ChEAT) is one of the most popular measuring tools for DEAB in children, but no French version is available. Moreover, while completion time is an important factor to be considered when working with children, only one recent study proposed a shorter version of the ChEAT. Taking the previous works of Murphy and colleagues (2019) as a starting point, the current study aimed to provide the first French-speaking validated 14-item short version of the ChEAT. METHODS: A sample of 1092 boys and girls aged between 8 and 12 years old were recruited in two urban areas in the province of Quebec, Canada. They completed the ChEAT, and their height and weight were measured at school. Factorial structure and internal consistency were assessed. RESULTS: After the initial factorial analysis, two "vomiting (or purging)" items were yielded as problematic and were thus removed from the analysis. The remaining 12 items provided a good fit to the data and a good internal consistency. Moreover, the factorial structure was proved to be invariant across sexes. CONCLUSION: This study is the first to provide a French assessment of DEAB in elementary school children. The French short version of the ChEAT provided a quick and reliable assessment for DEAB with non-clinical children population and could be used as a screening tool, even though no cut-off was established yet. LEVEL OF EVIDENCE: Cross-sectional, descriptive study, Level V.

Psychometric Properties of the Body Checking Questionnaire (BCQ) and of the Body Checking Cognitions Scale (BCCS): A Bifactor-Exploratory Structural Equation Modeling Approach.

This research sought to assess the psychometric properties of the French versions of the Body Checking Questionnaire and the Body Checking Cognitions Scale among community samples. A total sample of 922 adolescents and adults was involved in a series of two studies. The results from the first study supported factor validity and reliability of responses obtained on these two measures, and showed that both measures were best represented by a bifactor-exploratory structural equation modeling representation of the data. The results from the second study replicated these conclusions, while also supporting the measurement invariance of the bifactor-exploratory structural equation modeling solution and the equivalence of the correlations among the two measures (i.e., convergent validity) across samples. This second study also supported the criterion-related validity of ratings on both measures with measures of global self-esteem, physical appearance, social physique anxiety, fear of negative appearance evaluation, and disturbed eating attitudes and behaviors. Finally, the results of this last study also supported the measurement invariance and lack of differential item functioning of both measures in relation to sex, age, diagnosis of eating disorders, and body mass index.

Cross-Country Measurement Invariance and Effects of Sociodemographic Factors on Body Weight and Shape Concern-Related Constructs in Eight Countries.

The aim of this study was to examine the cross-country invariance of five well-established measures of body weight and shape concern-related attitudes and behaviors (i.e., drive for leanness, drive for muscularity, strategies to increase muscle, strategies to lose weight, and weight and shape concerns). A secondary objective was to examine the effects of several sociodemographic factors (age, BMI, socioeconomic status, and gender) on item and latent factor scores of these constructs. A total of 6272 emerging adults (4218 women; Mage = 21.46, SD = 3.11) from Australia, Belgium, Canada, China, Italy, Japan, Spain, and the U.S. completed a self-report online survey as part of a larger study. Overall, support for partial invariance both across countries and in terms of the considered sociodemographic factors was found for reduced versions of the five measures. Significant differences in latent means were found across countries, these being of greater magnitude for drive for leanness and strategies to lose weight. The considered sociodemographic factors (most notably BMI and gender) were associated with the latent mean scores of the assessed constructs. The present study contributes to current literature by providing cross-cultural invariant versions of several measures of relevance in the field of body image.

Psychometric properties of measures of sociocultural influence and internalization of appearance ideals across eight countries.

The aim of the current study was to examine the psychometric properties of two well-established measures of sociocultural influence and internalization of the thin/low body fat ideal and muscular ideal. Data from 6272 emerging adults (68.9 % female), aged 18-30 years from Australia, Belgium, Canada, China, Italy, Japan, Spain, and the U.S. were included in this study. Participants completed measures of pressure from mother, fathers, peers, and media, to both increase muscles and lose weight, as well as internalization of the thin/low body fat ideal and muscular ideal. Overall, support for partial invariance was found across the scales. In addition, group level differences were found between countries as well as along demographic factors including gender, age, body mass index, and socioeconomic status. These findings make an important contribution by identifying these scales as useful tools that will support future cross-country and cross-cultural examinations of explanatory models of the development of body image and eating concerns grounded within sociocultural theories.

Assessing positive body image, body satisfaction, weight bias, and appearance comparison in emerging adults: A cross-validation study across eight countries.

Positive body image refers to individuals' ability to conceptualize their bodies with love, respect, and appreciation. The study of positive body image is relatively new, and instruments used to investigate this multi-faceted construct have received limited use in non-English speaking countries. Thus, the aim of this investigation is to consider four measures that are associated with positive body image across eight different countries. Participants (n = 6272) completed the Body Appreciation Scale-2, the Body Areas Satisfaction Scale, the Physical Appearance Comparison Scale, and the Weight Bias Internalization Scale. Multi-group confirmatory factor analyses (MG-CFAs) and item-response theory (IRT) models were used to examine the measurement invariance of these surveys. Our results generally suggest that positive body image, weight bias, and appearance comparison can be assessed using brief assessments and that these four instruments can be used in different countries, but care should be taken to consider individuals' gender, BMI, and socio-economic position.

A cross-country examination of emotional eating, restrained eating and intuitive eating: Measurement Invariance across eight countries.

This study examined the measurement invariance of three scales that assessed emotional eating, restrained eating, and intuitive eating across eight countries (Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States) in order to determine their suitability for cross-country body image research. A total of 6272 young adults took part in this study. Participants completed an online survey including the Emotional Eating subscale of the Three Factor Eating Questionnaire-Revised 21, the Restraint subscale of the Eating Disorder Examination Questionnaire, and the Reliance on Hunger and Satiety Cues subscale of The Intuitive Eating Scale-2. Multi-group confirmatory factor analysis was used to evaluate potential cross-country differences in functioning of the measures. Partial invariance for all three scales was found, with only minor levels of non-invariance identified. Multiple indicator multiple cause models identified BMI and gender as potential influences on scores for these measures. Sources of invariance across groups are discussed, as well as implications for further substantive research across countries involving these measures.

Measuring perfectionism, impulsivity, self-esteem and social anxiety: Cross-national study in emerging adults from eight countries.

This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed the Multidimensional Perfectionism Scale (MPS), the UPPS-P Impulsive Behavior Scale, the 5-item Rosenberg Self-Esteem Scale (5-item RSES) and the Social Interaction Anxiety Scale (SIAS-6). Multigroup confirmatory factor analysis was run to examine cross-measure equivalence. Evidence for structural invariance was found for all questionnaires, while weak invariance was supported only for the 5-item RSES and the SIAS-6, and a partial weak invariance was found for the MPS and the UPPS-P. No measure achieved strong invariance. Strict invariance was achieved for the 5-item RSES, whereas only a partial strict invariance was supported for the MPS, UPPS-P and SIAS-6. These results suggest that perfectionism, impulsivity, self-esteem, and social anxiety are subjected to linguistic/cultural influence as well as to the effects of socio-demographic variables and can be evaluated by using the selected measures in eight different countries worldwide - but results should be interpreted with caution.

The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations.

The Breast Size Satisfaction Survey (BSSS) was established to assess women's breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η2 = .02-.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women's psychological and physical well-being.

The Paths to Children's Disordered Eating: The Implications of BMI, Weight-Related Victimization, Body Dissatisfaction and Parents' Disordered Eating.

Background: Being the target of peer victimization is frequent among children categorized as overweight and obese and is thought to play a central role in disordered eating behavior development. In accordance with a previous theoretical model, this cross-sectional study aimed to replicate among children the mediating role of weight-related victimization from peers and body dissatisfaction in the association between body mass index (BMI) and children's disordered eating attitudes and behaviors (CDEAB), while also taking into account the contribution of parents' disordered eating attitudes and behaviors (PDEAB). Methods: Participants were 874 children aged between 8 and 12 years old who were recruited in elementary schools. Height and weight were measured and used to calculate BMI. Self-reported questionnaires were used to measure weight-related victimization, body dissatisfaction, CDEAB and PDEAB. Results: For both girls and boys, a path analysis showed no direct effect of BMI on CDEAB, but a significant indirect effect was found, indicating that weight-related victimization and body dissatisfaction mediated this relationship. In addition, the indirect effect of weight-related victimization and body dissatisfaction remained significant even when controlling for PDEAB. Conclusion: While weight itself appears to be insufficient to explain CDEAB, weight-related victimization may lead children to see their weight as problematic and develop disordered attitudes and behaviors toward eating. This suggests that weight-related victimization from peers and body dissatisfaction must be taken seriously and that preventive and intervention efforts must be pursued.

Vinegar and weight loss in women of eighteenth-century France: a lesson from the past.

This short note reports the eighteenth-century account of Mademoiselle Lapaneterie, a French woman who started drinking vinegar to lose weight and died one month later. The case, which was first published by Pierre Desault in 1733, has not yet been reported by present-day behavioural scholars. Similar reports about cases in 1776 are also presented, confirming that some women were using vinegar for weight loss. Those cases can be conceived as a lesson from the past for contemporary policies against the deceptive marketing of potentially hazardous weight-loss products.