A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions.

PURPOSE OF REVIEW: Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions. RECENT FINDINGS: Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.

Body dissatisfaction among ethnic subgroups of Latin women: An examination of acculturative stress and ethnic identity.

This study investigated (1) ethnic group differences in body dissatisfaction (BD) among specific Latina subgroups, (2) acculturative stress as a mediator between ethnic group and BD, and (3) ethnic identification as a moderator between 3a) ethnic group and BD and 3b) acculturative stress and BD. Mexican (n = 30), Puerto Rican (n = 31), Cuban (n = 29), and non-Hispanic, White (n = 30) women in the US completed self-report questionnaires. Group comparisons indicated Mexicans reported greater BD compared to Whites, while Puerto Ricans and Cubans did not differ from Whites. A significant indirect effect indicated that acculturative stress mediated the association between ethnic group and BD. Acculturative stress predicted BD at low and average levels of ethnic identification. Additionally, there were significant differences comparing Cubans to Mexicans and Puerto Ricans, which were dependent on ethnic identification. Thus, higher ethnic identification may serve as a protective factor for Cubans. Findings support separating subgroups of Latinas and that higher ethnic identification may protect against the development of BD in Latinas experiencing acculturative stress. Assessments and interventions should address acculturative stress since higher levels were associated with higher levels of BD, and the combination of ethnic group, acculturative stress, and ethnic identification may help explain differences in BD among Latinas.

Psychosocial interventions to reduce eating pathology in bariatric surgery patients: a systematic review.

Bariatric surgery is the most effective treatment for severe obesity; however, a subset of patients experience suboptimal outcomes. Psychosocial interventions that address eating pathology may ameliorate negative consequences, although their efficacy has not been examined. Thus, a systematic review to evaluate the impact of psychosocial randomized controlled trials (RCTs) on eating pathology in adults pre and post-bariatric surgery was conducted. Six scientific databases were searched for psychosocial trials assessing eating pathology as an outcome. Ten RCTs representing seven distinct interventions were identified (i.e., four preoperative and six postoperative). Trials utilized cognitive-behavioral therapy, mindfulness-based approaches, acceptance-based treatment, motivational interviewing, and psychoeducational interventions. Findings provide initial support for reducing eating pathology pre and postoperatively in the short-term (i.e., 6 months); however, the small number of RCTs and heterogeneity among postoperative trials made it difficult to draw conclusions. Additional longitudinal studies are needed to determine the long-term impact of psychosocial interventions that address eating pathology in bariatric surgery patients endorsing significant eating pathology.

A pilot study of enhanced operation fit: The feasibility of a camp-based health intervention for ethnically diverse families of children with intellectual and developmental disabilities.

BACKGROUND: Obesity rates are higher in children with intellectual and developmental disabilities (DD) compared to typically developing (TD) children. In TD children, family-based (FB) interventions for obesity are the most effective interventions. Research addressing obesity interventions for children with IDD is limited. METHOD: We adapted a community-based obesity intervention created for TD children for children with IDD and added a parent education component. The current study examined the feasibility of Enhanced-Operation Fit, a camp-based intervention created in order to reduce weight, and improve health behavior outcomes. Participants were 16 children (68.8% male; Mage  = 13.15, SDage  = 1.62) and their parents. RESULTS: Results indicated that incorporating a daily parent education group limited recruitment potential, but showed promising preliminary improvements in parent feeding and child eating behaviors. CONCLUSIONS: Health interventions for children with IDD are greatly needed and the current study may be a cost and time-efficient intervention to help address this public health crisis.

Internalization of the Thin-Ideal and Eating Pathology in Kuwaiti Adult Women.

Rapid socioeconomic growth, Western acculturation, and thin-ideal internalization are theorized to be linked to dieting, weight concerns, and disordered eating in Arab countries. The purpose of this study was to examine eating pathology and the internalization of Western messages regarding the importance of thinness in a community sample of Kuwaiti women. Participants (N = 83) aged 18-35 years with BMIs between 17.58 and 24.88 (M = 21.30; SD = 1.83) completed measures of thin-ideal internalization and eating pathology. Results demonstrated that approximately 28% of the sample was at risk for eating pathology. Thin-ideal internalization was also found to significantly predict eating pathology. Study findings extend prior research on eating pathology in Arabic nations. This study is the first to examine the internalization of the thin-ideal in a community sample of Kuwait adult women and lends further support to the importance of continued research in this population.

The moderating role of resilience on the relationship between perceived stress and binge eating symptoms among young adult women.

OBJECTIVE: Adolescence and young adulthood are developmental periods during the life course that are sometimes associated with heightened stress and engagement in binge eating. Binge eating has been linked to psychiatric comorbidity, poorer physical health, and lower quality of life. However, less is known about protective factors that could buffer against binge eating behaviors. The current study examined the moderating role of resilience on the relationship between perceived stress and binge eating symptoms among emerging adult female college students. METHOD: Participants were 297 young adult women aged 18-25 years (Mage = 19.22, SD = 1.51; 52% self-identifying as a racial/ethnic minority) with Body Mass Index ranging from 15 to 66 (MBMI = 25.01, SD = 6.18). Women completed this cross-sectional study while they were attending universities in the Western or Southern United States. Participants provided demographic and height/weight information, and completed the following measures: Perceived Stress Scale, Binge Eating Scale, and Brief Resilience Scale. RESULTS: Higher perceived stress was significantly associated with more severe binge eating symptoms (b = 0.31; p < .01). In addition, higher resilience was associated with lower binge eating pathology (b = -0.20; p < .01). Moderation was supported as the relationship between perceived stress and binge eating symptoms varied by resilience level (b = -0.16; p < .01). CONCLUSIONS: Women who perceived higher stress were more likely to engage in binge eating relative to women experiencing low stress; however, resilience attenuated this association. Resilience could be targeted to reduce the negative effects of perceived stress on eating behaviors in young women.

The mediating role of appearance comparisons on the relationship between negative appearance commentary and binge eating symptoms.

While the frequency of weight-based teasing during childhood/adolescence has been linked to eating disturbance, limited research has examined the impact of negative appearance commentary experienced in young adulthood. Appearance comparisons have been shown to mediate the relationship between weight-based teasing frequency in childhood/adolescence and eating disturbance; however, less is known about the impact of other forms of negative appearance commentary and binge eating symptoms. The current study examined appearance comparisons to others as a mediator of the relationship between the impact of negative appearance commentary from interpersonal sources and binge eating symptoms in college women. Three hundred and seventeen young adult women from universities in the southwest and midsouth U.S. completed measures of appearance-related commentary, physical appearance comparisons, and binge eating symptoms. Controlling for body mass index, the mediation effect of appearance comparisons was tested using the PROCESS macro for SPSS. Appearance comparisons was a significant mediator of the relationship between the impact of negative appearance comments and binge eating symptoms, F(3,312)=40.256, p<0.001, R2=0.279. There was no direct effect of the impact of negative appearance comments on binge eating symptoms. Study findings indicate that appearance comparisons play a role in the extent to which the impact of negative appearance commentary influences binge eating symptoms. Results also suggest the need to address the impact of negative appearance commentary and appearance comparisons simultaneously in interventions for eating disorder psychopathology among college women.

Positive comments, negative outcomes? The potential downsides of appearance-related commentary in ethnically diverse women.

Although research has shown that appearance-related commentary influences body dissatisfaction and disordered eating, limited research has studied such commentary among ethnically diverse women. The current study examined ethnic group differences in the frequency and impact of appearance-related commentary and associations with body dissatisfaction and eating disorder psychopathology. Participants included 280 undergraduate women aged 18-25 (56.1% European American, 28.6% African American, and 15.3% Latina American). Results indicated no ethnic group differences in frequencies of positive weight/shape, positive general appearance, or negative weight/shape commentary while controlling for BMI. However, African American and Latina American women reported stronger negative responses to positive weight/shape commentary than European American women. Negative responses to positive weight/shape commentary were correlated with more body dissatisfaction in African American women, after controlling for frequency of commentary. Findings suggest that positive weight/shape commentary may be associated with poor outcomes in a subgroup of ethnic minority college women.

Adult and childhood weight influence body image and depression through weight stigmatization.

The goal of this study was to examine lifetime weight stigmatization as a mediator of the relationships among current body mass index, childhood overweight, depression, and body dissatisfaction. Participants were 299 female undergraduates (mean age = 20.52, standard deviation = 2.57; mean body mass index = 23.29, standard deviation = 4.51). Weight stigmatization significantly mediated the relationships between body mass index and body dissatisfaction, body mass index and depressive symptoms, and childhood overweight and depressive symptoms. The model accounted for 44.7 percent of the variance in depressive symptoms and 28.2 percent of the variance in body image dissatisfaction. Findings indicated that a decrease in weight stigmatization may predict better mental health.

Dietary Adherence, Glycemic Control, and Psychological Factors Associated with Binge Eating Among Indigenous and Non-Indigenous Chileans with Type 2 Diabetes.

BACKGROUND: Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients. PURPOSE: This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile. METHOD: Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants' weight, height, and glycemic control (HbA(1c)) were also obtained. RESULTS: Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being. CONCLUSION: Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.

A comparison of eating disorder psychopathology, appearance satisfaction, and self-esteem in overweight and obese women with and without binge eating.

This study investigated the differences in eating disorder psychopathology, appearance satisfaction, and self-esteem between 194 overweight/obese college women with and without binge eating. Participants were categorized as binge eating (BE; n=56) or non-binge eating (NBE; n=138) based on reports of binge eating at least once per week on average for the past 28days and no episodes of vomiting or laxative use in the past 28days. The BE group had significantly greater levels of eating, weight, and shape concerns and lower levels of appearance satisfaction and self-esteem than the NBE group. For the BE group, binge eating frequency was negatively correlated with dietary restraint. Results are generally consistent with studies utilizing clinical and community samples. The findings extend such research by examining binge eating in a sample of overweight and obese college women and indicating that overall appearance satisfaction is lower among women with binge eating. Study findings also highlight potential issues to address in obesity and binge eating intervention efforts for college populations. Future research is needed to replicate these findings in additional samples of college women and men.

Differences in appearance-related commentary, body dissatisfaction, and eating disturbance among college women of varying weight groups.

This study examined appearance-related commentary, body dissatisfaction, and eating disturbance in 924 undergraduate females. Significant group differences were found in type of appearance-related commentary received across weight groups. Overweight and obese women experienced negative weight and shape-related comments at greater frequencies and positive weight and shape-related comments at lower frequencies compared to underweight and normal weight women. A higher frequency of positive weight and shape-related commentary was associated with less body dissatisfaction for all women and less shape and weight concerns for obese women. These findings suggest that the weight status of young women likely influences the appearance-related commentary that they receive and the manner in which such commentary affects their body image and eating behaviors.

The effects of ambiguous appearance-related feedback on body image, mood states, and intentions to use body change strategies in college women: An experimental study.

The current study evaluated the effects of receiving ambiguous appearance-based or nonappearance-based feedback on body image, mood states, and body change strategies. One hundred and forty-six women were randomly assigned to either an appearance condition, wherein they interacted with a confederate supposedly working for a cosmetic surgery center, or a nonappearance condition, in which the confederate purportedly worked for an academic enhancement center. Counter to expectations, there was no evidence of significant group differences on most of the variables that assessed mood states and body change strategies. However, intentions to engage in bulimic behavior were significant higher and dieting intentions marginally higher at posttest for the appearance condition, however anger levels were significantly higher for the nonappearance condition. Limitations of the study are discussed and future indications for research in this area are suggested.

Compensatory eating disorder behaviors and gastric bypass surgery outcome.

OBJECTIVE: This study prospectively examined the role of compensatory eating disorder behavior on gastric bypass (GB) surgery weight-loss outcome. METHOD: The compensatory behaviors of 199 GB patients were evaluated presurgically using the Questionnaire of Eating and Weight Patterns. Hierarchical linear regression was used to assess the presence of compensatory behavior on 6-month postsurgery body mass index (BMI), and 1-year postsurgery BMI, controlling for age, sex, race, age becoming overweight, number of weeks postsurgery, and presurgery BMI. RESULTS: The presence of presurgery compensatory behavior emerged as a small but significant predictor of lower BMI 6-months postsurgery although not at 1-year postsurgery. Other common predictors for lower BMI at 6-months and 1-year postsurgery were lower presurgery BMI and greater number of weeks postsurgery. Female sex also predicted lower BMI 1-year postsurgery. DISCUSSION: These results must be taken with caution as they contradict clinical guidelines. Future research is needed to replicate these findings.

Relations among multiple peer influences, body dissatisfaction, eating disturbance, and self-esteem: a comparison of average weight, at risk of overweight, and overweight adolescent girls.

OBJECTIVE: The goal of this study was to evaluate peer-related influences on appearance, body dissatisfaction, eating disturbance, and self-esteem in average weight, at risk of overweight, and overweight adolescent girls. METHODS: Three hundred twenty-five adolescent girls from high schools in Florida were assessed. Ninety met criteria for being at risk of overweight or overweight. Logistic and multiple regression analyses were used to evaluate group differences on all variables and to assess the amount of variance accounted for by peer-influence variables in the prediction of body dissatisfaction, eating disturbance, and self-esteem. RESULTS: Overweight and at risk of overweight girls scored higher than average weight girls on body dissatisfaction, dieting, and a peer measure that assessed negative comments and attributions about appearance. They also scored lower than average weight girls on self-report measures that assessed conversations about appearance and anti-dieting advice. How influential friends were in determining one's body image was a unique predictor of body dissatisfaction but only for the overweight and at risk of overweight group. CONCLUSIONS: Possible implications for clinical intervention programs are discussed along with directions for future research.

Appearance-related commentary, body image, and self-esteem: Does the distress associated with the commentary matter?

Research that has examined the association between appearance-based commentary and body image has generally focused on the frequency of occurrence of the commentary, not the subjective rating of the distress associated with the feedback. The current study examined both frequency and distress (effect) components of commentary in a sample of 246 undergraduate female students aged 18-25. Significant correlations were found between both frequency and effect dimensions of commentary and measures of body image disturbance and self-esteem. The utility of both frequency and effect variables in predicting body image disturbance and self-esteem was demonstrated in regression analyses. Implications of the findings for broadening the assessment of appearance-based commentary to include both dimensions of the construct are discussed.

Development and validation of the verbal commentary on physical appearance scale: Considering both positive and negative commentary.

Two studies describe the development and validation of the Verbal Commentary on Physical Appearance Scale (VCOPAS). In Study 1, 320 undergraduate female students completed the scale and factor analyses were conducted. Study 2 included 246 undergraduate female students and a confirmatory factor analysis (CFA) replicated the initial factor structure. The final VCOPAS consists of 21 items and contains three subscales (Negative Weight and Shape, Positive Weight and Shape, and Positive General Appearance). The total scale and subscales demonstrated good internal consistency and test-retest reliability (all >.70). Significant correlations were found between VCOPAS subscales and measures of physical appearance-related feedback, body image disturbance, and self-esteem. Regression analyses indicated the utility of the Negative Weight and Shape, Positive Weight and Shape, and Positive General Appearance subscales in explaining significant variance associated with body image disturbance and self-esteem. The VCOPAS is likely to be useful in future research examining the role of appearance-related commentary in the development and maintenance of body image dissatisfaction and eating disturbance.

Media exposure, mood, and body image dissatisfaction: an experimental test of person versus product priming.

In the current study, 138 college females were randomly assigned to four media exposure conditions based on the presence or absence of an attractive person (fashion model) and the presence or absence of an appearance-related product. Outcome measures consisted of visual analogue ratings of multiple body image and mood variables. The results revealed a significant main effect for person, indicating that the presence of a model increased levels of body dissatisfaction and negative mood. No product effect emerged and there was no significant interaction between person and product. These findings suggest that the appearance priming effect of media exposure on body dissatisfaction and mood is specific to a person stimulus, with no additional effect promoted by a generic appearance-relevant stimulus.

The Physical Appearance Ambiguous Feedback Scale (PAAFS): a measure for indexing body image related cognitive bias.

Recent conceptualizations of body image disturbance have included an information processing model that includes a focus on an interpretive information processing bias. Study 1 involved the development and validation of a measure of appearance-based cognitive bias, the Physical Appearance Ambiguous Feedback Scale (PAAFS). In Studies 2 and 3, two samples of college females (n=313) were tested and the psychometric characteristics of the PAAFS were evaluated. Reliability was acceptable and convergence with measures of body image and eating disturbance was moderate. In Study 4, 313 college females completed the PAAFS in the laboratory based on an instructional content designed to induce processing bias. Preliminary evidence indicates that the PAAFS appears to be sensitive to instructional set manipulations and dispositional level of body dissatisfaction.

Beauty and thinness messages in children's media: a content analysis.

Research suggests that young children have body image concerns, such as a desire for thinness and an avoidance of obesity. Surprisingly, few studies have investigated how children's body preferences and stereotypes are influenced by media aimed at children. In order to gain a better understanding of the content of such media, a content analysis was used to examine body image-related messages in popular children's videos and books. Results indicated that messages emphasizing the importance of physical appearance and portraying body stereotypes are present in many children's videos but relatively few books. Of the videos examined, the ones that exhibited the most body image-related messages were Cinderella and The Little Mermaid. Indian in the Cupboard and ET were the videos with the least number of body image-related messages. Of the books studied, the one with the highest number of body image-related messages was Rapunzel. Ginger and The Stinky Cheese Man were the only books studied that did not exhibit body image-related messages. Implications of an association of beauty and thinness in children's media are explored.