Adaptation and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) for use in english among adolescents in urban India.

Body image concerns are a global issue among adolescents, including in India. These concerns can prevent adolescents from engaging in everyday life activities, impeding social and academic development. However, at present, there are no psychometrically valid measures to assess such impact in the Indian context. This study culturally adapted and validated the Body Image Life Disengagement Questionnaire (BILD-Q) for use in English among adolescents in urban India. A total of 1427 adolescents completed an adapted version of the BILD-Q along with additional measures pertaining to body image. Exploratory factor analysis identified one dimension of body image life disengagement, which provided the best fit. The 9-item one-factor model was further supported by confirmatory factor analysis. The scale demonstrated good internal consistency and test re-test reliability. Further analysis demonstrated that the scale can be used to compare scores between boys and girls without measurement bias. This study presents a culturally adapted version of the BILD-Q, which can be used as a valid and reliable measure to assess the impact of body image concerns on life disengagement among English-speaking adolescents in urban India.

A short-form drama series created for the digital media environment: A randomised controlled trial exploring effects on girls' body satisfaction, acceptance of appearance diversity, and appearance-related internalised racism.

'Edutainment' micro-interventions are a scalable public health strategy that can challenge media-related body image pressures and race- and weight- based stigma. This study evaluated the impact of viewing a brief, theoretically-informed, short-form drama episode on Black and non-Black adolescent girls' body image, acceptance of diversity of appearance (assessed by acceptance of an individual in a larger body and a Black individual), and appearance-related internalised racism (among Black girls only). The fictional drama depicted characters of diverse body sizes and race/ethnicities, with each episode focusing on a risk or protective factor for body image concerns among adolescent girls (e.g., appearance-related teasing and conversations). Participants (N = 686; 50.4 % Black, 49.6 % non-Black) aged 13-18 (Mage = 15.72 years) were randomly allocated to view either the first episode of this series (focused on social media's unrealistic appearance ideals and strategies to resist pressures) or a non-body-image-related control video. Findings revealed no significant differences in body satisfaction between conditions but significant improvements in the acceptance of appearance diversity among all girls who viewed the body image episode. Black girls who viewed this episode experienced significant improvements to appearance-related internalised racism. Edutainment micro-interventions constitute a promising avenue for promoting acceptance of appearance diversity and reducing appearance-related internalised racism.

Adaptation and Validation of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) for Use in English among Adolescents in Urban India.

Eating pathology is increasingly common among Indian adolescents. However, brief validated measures of disordered eating in Indian contexts are scarce. This study adapted and validated a culturally appropriate English language version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) among 385 adolescents (mean age = 13.42 years; 47.3% girls) in urban India. Confirmatory factor analysis indicated that a two-factor eight-item solution had an acceptable fit to the data across gender: an 'Eating Concerns and Restraint' subscale and a 'Weight and Shape Concerns' subscale. Further, the questionnaire can be utilised as both a unidimensional and multidimensional tool. This allows for the computation of a total score on the primary factor of 'Child Eating Pathology', as well as the two subscales. Internal consistency of the 'Weight and Shape Concerns' subscale (α = 0.825) and 'Eating Concerns and Restraint' subscale (α = 0.649) was satisfactory. Concurrent validity was established through medium significant correlations with measures of body image and broader mental health. The results support the use of the ChEDE-Q for assessing disordered eating among urban Indian adolescents, thus providing the research community and practitioners with a measure to investigate the nature and scale of disordered eating among adolescents in India.

"Like putting on an old pair of gloves" or "realising i am actually over it": a qualitative study exploring the impact of the COVID-19 pandemic lockdown restrictions on eating disorder recovery in the UK.

The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-023-04353-2.

Evaluating a body image school-based intervention in India: A randomized controlled trial.

Body dissatisfaction is highly prevalent among adolescents in low- and middle- income countries, including in India. However, evidence-based interventions are lacking. This study evaluated the efficacy of a school-based mixed-gender body image intervention among adolescents in India. A randomized controlled trial was conducted among 568 (43 % girls) Year 7 students (aged 11-14; 94 % aged 12-13) in six schools in Delhi. Each school was randomly allocated to receive five 45-minute intervention sessions delivered by trained psychologists or a wait-list control condition. The primary outcome of body image and related secondary outcomes were assessed at pre-intervention, post-intervention, and 3-month follow-up. Intention-to-treat linear mixed models analyses showed improvements in body image relative to the control group at post-intervention and 3-month follow-up. Significant improvements were identified at post-intervention for internalization, life disengagement, disordered eating, self-esteem, and negative affect, with effects maintained in nearly all outcomes (girls only - internalization, boys only - life disengagement) at 3-month follow-up. This study presents the first mixed-gender school-based body image intervention in India, which was efficacious in improving urban adolescents' body image, disordered eating, and related outcomes.

"I listen to my body now": a qualitative exploration of positive body image in breast cancer survivors .

OBJECTIVE: Existing research has identified the high prevalence of body image concerns among female breast cancer survivors. However, it has neglected to explore the experience of positive body image among this group, despite its potential utility for intervention development. The present study therefore aimed to explore the experiences of breast cancer survivors who self-identified as experiencing a positive relationship with their post-treatment bodies. DESIGN: Twenty-two participants (M age = 54, SD = 8.38) were interviewed using a semi-structured approach. RESULTS: Thematic analysis identified three overarching themes amongst the qualitative data: (1) Resisting appearance pressures, (2) Receiving care, and (3) Self-worth beyond appearance. Findings indicated that women's life experiences had led them to develop a critical awareness of the unrealistic nature of appearance ideals. Their experience of positive body image was also attributed to engaging in self-care and receiving supportive care from others. Finally, women expressed prioritising functionality and health over their physical appearance. CONCLUSION: The present findings advance the theoretical understanding of positive body image in a breast cancer population. They also provide an opportunity to test theorised models of positive body image.

A comic-based body image intervention for adolescents in semi-rural Indian schools: Study protocol for a randomized controlled trial.

Adolescents in India experience body dissatisfaction, however, empirically supported interventions are lacking. This paper describes the protocol for the development, acceptability testing, and cluster randomized controlled trial (RCT) of a six-session comic-based intervention, which aims to improve body image and related outcomes among adolescents in semi-rural Indian schools. If found to be acceptable and effective, UNICEF will disseminate the intervention across schools in eight states of India. The acceptability study will be conducted with 24 students in Classes 6-8 (age 11-14) and nine teachers from Hindi-medium government schools using interviews and focus groups. The subsequent RCT will be conducted with 2400 students, with schools randomized to either the comic-based intervention or lessons-as-usual (control) groups. The primary outcome is body esteem, and secondary outcomes are disordered eating, appearance ideal internalization, body-image-related life disengagement, self-esteem, negative affect, and positive affect. Additional exploratory outcome measures are skin colour dissatisfaction, body hair dissatisfaction, appearance-based teasing, and endorsement of traditional gender roles. These outcomes will be examined at three timepoints: baseline (T1), 1 week-post-intervention (T2), and 12-weeks follow-up (T3). Analyses will compare outcomes in the intervention with the control group. This will be the first study to evaluate a body image intervention for adolescents in semi-rural Indian schools.

Exploring the experiences and psychosocial support needs of informal carers of men with breast cancer: a qualitative study.

PURPOSE: The provision of practical and emotional support for men who have been diagnosed with breast cancer in the UK falls primarily on their partners, close family members or friends. However, informal carers' experiences are omitted from the research literature. Therefore, the present study aimed to explore the care-giving experiences of informal carers (ICs) of men with breast cancer in the UK and identify psychosocial support needs and preferences. METHODS: Semi-structured interviews, conducted on the telephone or via online video calls, explored ICs' experiences of providing support, the psychosocial issues they faced and the impact of the illness on themselves and their relationship with the patient. They were also asked about any support previously offered to them, in addition to their support preferences. Twelve ICs participated (11 females, 1 male), and 9 were spouses. Interview transcripts were analysed with reflexive thematic analysis using NVIVO software. RESULTS: Four key themes were identified: "The impact of caring", "Lack of awareness", "Isolated and alone" and "Making a difference". CONCLUSIONS: The physical, emotional, financial and social impact of providing emotional and practical care and support for a man diagnosed with breast cancer can be considerable. ICs may experience significant levels of distress and often feel isolated. Greater awareness and more research is needed to better understand the psychosocial impact and support needs for ICs of men with breast cancer. There is an evident necessity to address their information needs and offer sources of support throughout the cancer journey.

A qualitative exploration of motivations for fasting and the impact of Ramadan on eating behaviors and body image among young adult Muslim women in the United Kingdom.

Research exploring the impact of fasting in Ramadan on eating behaviors has focused on Muslim-majority countries and has neglected to examine impacts beyond the month when "normal" eating patterns resume. This study aimed to explore the experiences of United Kingdom-residing young adult Muslim women who were fasting in Ramadan to understand its impact on their body image and eating behaviors both during and 1-month following Ramadan. In-depth, semi-structured interviews were conducted with 14 Muslim women aged between 18 and 35 (Mage = 27.3) at two distinct time-points: during the last week of Ramadan and 1-2 months later. The interviews explored questions related to motivations for fasting, experience of fasting in Ramadan, and eating behaviors and thoughts related to body image and appearance. Thematic Analysis revealed three themes: (1) family and community expectations to fast (2) exertion of control of on eating behaviors and (3) preoccupation with weight and appearance. The results suggest that family and community play a strong role in motivating women to fast during Ramadan, alongside the need to feel a sense of belonging to their community. This can conflict with the pressure and desire to assimilate with Western culture and associated appearance ideals, thus putting women at greater risk of disordered eating and body image concerns. These findings suggest important implications for increased support in the Muslim community, and the need for further research to explore this topic across longer time-points and in different cultural groups.

Acceptability and preliminary efficacy of a school-based body image intervention in urban India: A pilot randomised controlled trial.

This pilot study evaluated the acceptability and preliminary efficacy of a culturally adapted school-based body image intervention, Dove Confident Me, for use in urban India. Two private schools in New Delhi were randomly assigned at the school level to receive either the five-session intervention facilitated by trained psychologists or lessons-as-usual (control). Participants were Year 7 students (N = 166; Mage = 11.9 years). Students, facilitators, and observing teachers, provided acceptability feedback. Fidelity was assessed. Body image and related measures were completed by students in a classroom setting at pre-intervention, post-intervention, and two-month follow-up. Most students enjoyed (73.7 %) and understood (84.2 %) the intervention. Facilitators (90 %) and observing teachers (70 %) reported that the learning objectives were achieved. Adherence and facilitator competence were rated as very good. Body esteem improved significantly among intervention students at post-intervention and follow-up (Cohen's ds = .45-.46), relative to control students. Positive affect also improved at post-intervention (d = .58). No significant effects on internalisation, life engagement, eating pathology, self-esteem, or negative affect emerged. This study provides evidence for the acceptability and preliminary efficacy of Dove Confident Me in urban India. Intervention refinements to increase acceptability and efficacy are recommended.

Cultural adaptation and validation of the Body Esteem Scale for Adults and Adolescents for use in English among adolescents in urban India.

Body image research is growing in India; however, there are no psychometrically valid measures to assess body image concerns among an Indian population. In this study, the Body Esteem Scale for Adults and Adolescents (BESAA) underwent adaptation and validation among urban Indian adolescents in English. Cultural adaptations were made in consultation with body image experts and acceptability interviews with adolescents in India. 1462 adolescents living in Northern India completed the adapted BESAA and measures to assess construct validity. For girls, a 15-item three-factor model provided the best fit to our data, using exploratory factor analysis, with 'Appearance-Negative', 'Appearance-Positive', and 'Weight' subscales. For boys, a 7-item two-factor model provided best fit, with 'Appearance-Negative' and 'Appearance-Positive' subscales. Models were confirmed via confirmatory factor analysis. The scales demonstrated good internal consistency and satisfactory test-retest reliability. Construct, convergent validity was supported for girls and boys through significant correlations with figure rating scales and disordered eating. Further analyses using common items across the female and male scales, produced a psychometrically sound scale that can be used comparatively across genders. This study presents a culturally adapted, shortened BESAA as a valid and reliable measure to assess body image concerns in English among urban Indian adolescents.

Adaptation and validation of the Internalisation-General subscale of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) in English among urban Indian adolescents.

Few studies have validated body image related measures in Asian countries, including in India, thus stunting research progress. To provide a robust method of assessing internalisation of cultural appearance ideals, the purpose of this study was to validate a culturally appropriate English version of the Internalisation-General subscale from the Sociocultural Attitudes Towards Attitudes Questionnaire-3 among a school sample of 1,432 urban Indian adolescents (Mage = 12.9 years; 44 % girls). Exploratory factor analyses revealed a one-factor solution for both girls and boys. Analyses indicated a six-item scale for girls and a four-item scale for boys; both of which were verified by confirmatory factor analysis. Cronbach's alpha was high for both female (.88) and male scales (.87), and convergent validity was confirmed via significant correlations with measures of body esteem and disordered eating. Using the items which were common in both the male and female versions of the scale, confirmatory factor analysis supported a psychometrically sound model that was gender invariant, and thus can be used to assess and compare both genders. Overall, results support the reliability and validity of the Internalisation-General subscale among English-speaking urban Indian adolescents.

Adaptation and validation of the Eating Disorder Examination-Questionnaire in English among urban Indian adolescents.

OBJECTIVE: Eating pathology is a salient issue in India, with clinical features reported among adults and adolescents. However, there are currently no validated measures of disordered eating in the Indian context. The present study therefore aimed to validate a culturally appropriate English language version of the Eating Disorder Examination Questionnaire (EDE-Q), a widely used measure, among adolescents in India. METHOD: We adapted and examined the factor structure, reliability, and construct validity of the EDE-Q among an urban sample of 1,413 Indian adolescents (mean age = 13 years; 45% girls). RESULTS: In contrast to the original four-factor model, exploratory factor analysis identified a two-factor solution for girls and boys, which was verified by confirmatory factor analysis; a "Preoccupation and Control" subscale and a "Weight and Shape Concerns" subscale. The total scale comprised 15 items for girls and 18 items for boys. Test-retest reliability and internal consistency were satisfactory for the girls' and boys' scales (Cronbach's α = .91 for both) and their comprising subscales (αs ≥ .80). Concurrent validity was established through medium-high significant correlations with measures of body image and internalization of appearance ideals. Combining items common to both versions of the scale led to a psychometrically acceptable model which was largely invariant across both genders, thus facilitating gendered comparison. DISCUSSION: Findings indicate the reliability and validity of the EDE-Q among English-speaking urban Indian adolescents. This will facilitate further research examining the prevalence and nature of eating pathology among adolescents in India.

Body dissatisfaction predicts the onset of depression among adolescent females and males: a prospective study.

RATIONALE: Body dissatisfaction is prevalent in mid-adolescence and may be associated with the onset of depression. OBJECTIVE: The study assessed the influence of body dissatisfaction on the occurrence of later depressive episodes in a population-based sample of British adolescents. METHOD: Participants were 2078 females and 1675 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of depressive episodes at 18 years old, controlling for baseline depression. RESULTS: Among females, body dissatisfaction predicted mild (OR=1.63, 95% CI=1.31, 2.04), moderate (OR=1.67, 95% CI=1.28, 2.18) and severe depressive episodes (OR=1.84, 95% CI=1.09, 3.12). Among males, body dissatisfaction predicted mild (OR=1.50, 95% CI=1.00, 2.25) and severe depressive episodes (OR=2.85, 95% CI=1.18, 6.87) at 18 years of age. CONCLUSIONS: This is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of later depressive episodes in a cohort born in the early 1990s. The findings highlight that body dissatisfaction is a public health concern.

Psychological and sociocultural influences on body image among midlife women with and without a history of breast cancer: Testing the Tripartite Influence Model of Body Image.

Body image concerns are common among breast cancer survivors and women in midlife. However, effective interventions are lacking for breast cancer survivors. This may be related to prior research having examined non-modifiable and medicalised influences on body image, instead of modifiable sociocultural and psychological influences. An adaptation of the 'Tripartite Influence Model of Body Image' was tested among women with (n = 169; mean age = 49.9) and without (n = 323; mean age = 47.6) a history of breast cancer, to investigate whether psychological and sociocultural influences on body image were similar between groups. Structural equation modelling revealed the model fit was satisfactory. Media pressure had an indirect effect on body image among both groups, and a direct effect among women treated for breast cancer. An additional influence of relevance only to women without breast cancer was pressure from friends. Overall, findings indicate common influences of media pressure and appearance comparisons on body image among both groups of women. This suggests that with some tailoring, existing evidence-based body image interventions designed for midlife women targeting these factors may also be relevant and beneficial for breast cancer survivors.

The effectiveness of brief animated films as a scalable micro-intervention to improve children's body image: A randomised controlled trial.

Creating media to counteract the plethora of media and advertising that perpetuates negative body image is a scalable public health strategy that can be achieved through innovative micro-interventions. This study examined the immediate and short-term (one-week follow-up) impact of viewing brief, evidence-informed animated films on young people's body image, media literacy, and self-efficacy in addressing appearance teasing. The animations were co-created through a partnership among academics, a personal care brand's social mission, and a children's television channel. Participants aged 7-14 (N = 1329, 49 % girls) were randomised into one of three viewing conditions: Appearance Teasing & Bullying, Media & Celebrities, or a non-appearance-related animation. Contrary to predictions, all three animations were comparably effective at eliciting intervention effects. For girls and boys aged 7-10, all three animations immediately improved state body satisfaction (+boys aged 11-14; Cohen's ds = .60-.71) and led to sustained improvements in trait media literacy (+girls aged 11-14; ds = .38-.61), sensitivity to appearance teasing (+boys aged 11-14; ds = .35-.48), and willingness to ignore appearance teasing (7-10 years only; ds = .34-.74) at one-week follow-up. Findings indicate that children's media is an effective medium for developing micro-interventions.

Prospective Pathways to Depressive Symptoms and Disordered Eating in Adolescence: A 7-Year Longitudinal Cohort Study.

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls.

Cognitive-behavioral roots of body image therapy and prevention.

The existing array of evidence-based body image prevention and intervention approaches has evolved over time. However, the majority originated directly or indirectly from a cognitive-behavioral conceptualisation of body image pioneered by Thomas F. Cash. In this way, it is difficult to overstate the impact Tom Cash has had on body image intervention research and practice. His ground-breaking work, building on the work of Schilder and Fisher, was the first to provide a comprehensive model of body image that reflected the broad range of influences and consequences of body image. His differentiation of the components of body image as a construct and between body image traits and states allowed us to identify and influence targets for intervention. Moreover, the intervention strategies that Tom Cash employed are still used today and laid the foundations for contemporary intervention programs. There is a gap of more than 15 years between the first and last of us receiving our PhDs, yet Cash's work has been an important influence on us all. We are extremely grateful for the theoretical and practical tools that he has given to our field. In this paper, we will outline how Cash's work has informed contemporary body image intervention and prevention. We will describe Cash's theory and intervention tools before discussing how this work paved the way for subsequent research and practice.

Adolescent body dissatisfaction and disordered eating: Predictors of later risky health behaviours.

RATIONALE: Body dissatisfaction is prevalent among teenagers, and may influence the uptake of risky health behaviours. OBJECTIVE: The study assessed the influence of body dissatisfaction on smoking, cannabis use, drug use, self-harm, gambling, and drinking and the mediating role of disordered eating in a population-based sample of British adolescents. METHOD: Participants were 2634 females and 1684 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of risky health behaviours at 21 years old. Mediation analysis tested the mediating role of disordered eating at 16 years old on each risky health behaviour. RESULTS: Among females, body dissatisfaction predicted smoking (OR = 1.40, 95% CI = 1.15, 1.72), cannabis use (OR = 1.20, 95% CI = 1.00, 1.43), drug use (OR = 1.51, 95% CI = 1.20, 1.90), self-harm (OR = 1.44, 95% CI = 1.13, 1.84) and high-risk drinking (OR = 1.41, 95% CI = 1.10, 1.80). Disordered eating symptoms had mediating effects on some behaviours. Among males, body dissatisfaction predicted smoking (OR = 1.44, 95% CI = 1.14, 1.81) and no effect of disordered eating was found on any risky health behaviour. CONCLUSIONS: This is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of several risky health behaviours, and elucidates the mediating role of disordered eating. The findings highlight that body dissatisfaction is a public health concern. Early interventions to promote body satisfaction may reduce the prevalence of later risky health behaviours.

A pilot study of a body image intervention for breast cancer survivors.

Body image interventions for breast cancer survivors are lacking in empirical support. Examining existing research on effective body image interventions for women in midlife more broadly may provide useful insights. This pilot study assessed the acceptability, feasibility, and preliminary effects of a Cognitive Behavioural Therapy-based intervention adapted from women in midlife to promote positive body image among breast cancer survivors. Twenty-two breast cancer survivors received the 7-week group intervention, co-facilitated by a clinical psychologist and peer. Participant evaluations suggested the intervention was both acceptable (e.g., 94% would recommend it) and feasible (e.g., 91% completed the intervention). Improvements were identified at either post-test or 1-month follow-up in nearly all body image measures. Maintained improvements were found in body appreciation, weight and shape concern, acceptance of aging-related appearance changes, and self-esteem. This study suggests that the adapted intervention is acceptable, feasible, and demonstrates preliminary efficacy in improving body image and secondary outcomes among breast cancer survivors.