Greek adaptation of the Teruel Orthorexia Scale (TOS) in adults from the Republic of Cyprus: A bidimensional model may not be universal.

The Teruel Orthorexia Scale (TOS) is a 17-item instrument designed to assess distinct facets of Orthorexia Nervosa (ON) and Healthy Orthorexia (HO). While a bidimensional model of TOS scores has been supported in diverse national and linguistic groups, the psychometric properties of the TOS have not been previously assessed in Greek-speaking populations. To rectify this, we assessed the psychometric properties of a novel Greek translation of the TOS in a sample of adults from Cyprus. A total of 1248 respondents (710 women, 538 men) completed the Greek TOS, as well as previously validated measures of perfectionism, obsessive-compulsive symptomatology, eating restriction, negative affect, and appearance evaluation. Our results showed that a bidimensional model of the TOS had less-than-adequate fit when modelled using both confirmatory factor analysis and exploratory structural equation modeling (ESEM). Conversely, both exploratory factor analysis and ESEM supported extraction of a 3-factor model consisting of a HO facet and separate components of emotional orthorexia and cognitive-social orthorexia. This 3-factor model showed a lack of measurement bias (measurement invariance across gender identity and lack of differential item functioning as function of age and body mass index), but there were differences in latent factor means as function of respondent age and body mass index. The 3-factor model showed adequate evidence of construct validity, with the latent emotional orthorexia and cognitive-social orthorexia facets showing significant and moderate associations with the additional constructs measured in the survey. Broadly speaking, these findings support the psychometric properties of a 3-factor model of the Greek TOS, but also suggest that the bidimensional model of the TOS may not have universal applicability. We encourage further assessments of factorial validity in other national and linguistic contexts.

Body Image, Media Influences, and Situational Dysphoria in Individuals with Visible Physical Disabilities.

Body image in individuals with visible physical disabilities appears to be an important area of research and investigation, which has received little attention over the years. The purpose of the current descriptive, cross-sectional study was to investigate relationships between the body image construct, possible media influences on body image satisfaction, self-esteem, and the novel variable of situational body image dysphoria in individuals with visible physical disabilities. One hundred fifty-four men and women responded to the measures of interest. Results indicated that appearance satisfaction, weight-related anxiety, pressures from the media, and the internalization of the thin ideal were significant predictors of situational body image dysphoria. Additionally, when controlling for type of disability, females face more difficulties concerning only some of the variables of interest. These findings have important implications for practice with regards to screening measures, the education of healthcare professionals, as well as intervention and rehabilitation programs.

La imagen corporal en personas con discapacidades físicas visibles parece ser un área importante de investigación y estudio, que ha recibido poca atención a lo largo de los años. El propósito del presente estudio transversal descriptivo fue investigar las relaciones entre la construcción de la imagen corporal, las posibles influencias de los medios en la satisfacción con la imagen corporal, la autoestima y la nueva variable de disforia situacional de la imagen corporal en personas con discapacidades físicas visibles. Ciento cincuenta y cuatro hombres y mujeres respondieron a las medidas de interés. Los resultados indicaron que la satisfacción con la apariencia, la ansiedad relacionada con el peso, las presiones de los medios y la internalización del ideal de delgadez fueron predictores significativos de la disforia situacional de la imagen corporal. Además, cuando se controla por el tipo de discapacidad, las mujeres enfrentan más dificultades con respecto a solo algunas de las variables de interés. Estos hallazgos tienen implicaciones importantes para la práctica con respecto a las medidas de detección, la educación de los profesionales de la salud, así como los programas de intervención y rehabilitación.

Exploring the role of positive body image in healthy orthorexia and orthorexia nervosa: A gender comparison.

Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; age M = 40.30, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.

Psychometric properties of a Greek translation of the Functionality Appreciation Scale (FAS) in adults from the Republic of Cyprus.

The Functionality Appreciation Scale is a widely used instrument for the measurement of an individual's appreciation of their body for what it can do and is capable of doing (i.e., functionality appreciation). In the present study, we examined the psychometric properties of a novel Greek translation of the FAS in Cypriot adults. A total of 448 women and 345 men from the Republic of Cyprus completed the FAS, as well as validated measures of body appreciation, appearance evaluation, and symptoms of disordered eating, and self-esteem. Exploratory and confirmatory factor analyses supported a unidimensional model of FAS scores, with all 7 items retained. Scores achieved scalar invariance across gender, with the gender difference in FAS scores not reaching significance. FAS scores were also found to have adequate composite reliability and convergent (significant associations with body appreciation, appearance evaluation, and symptoms of disordered eating) and concurrent validity (significant associations with self-esteem). Finally, functionality appreciation predicted self-esteem once the effects of all other variables had been accounted for, supporting incremental validity. Overall, these results suggest that the Greek FAS is a psychometrically valid tool for the assessment of functionality appreciation in adults from Cyprus.

Validation of a Greek adaptation of the Anti-Fat Attitudes Questionnaire.

The Anti-Fat Attitudes Questionnaire (AFA) measures prejudicial attitudes that are held about individuals with overweight BMI or obesity. Despite increased interest in research on anti-fat attitudes worldwide, the psychometric properties of the AFA have rarely been examined in non-English speaking populations. The present study aimed to address this gap in the literature by translating and validating the AFA in the Greek language. An online, community-based sample of 642 individuals (364 women) responded to the Greek translation of the AFA and measures of appearance satisfaction and appreciation, disordered eating, self-esteem and depression. Results indicated that the original three-factor solution of the AFA was maintained in both the Principal and Confirmatory Factor Analyses. Additionally, internal consistency, test-retest reliability and convergent validity all showed adequate results. These findings provide support for the use of the AFA in Greek-speaking populations. The availability of the Greek AFA adds to the toolbox of body image scholars working in the Greek context.

Intuitive eating in Greek-Cypriot adults: Influence of gender and body mass.

Introduction: To date, research on eating behaviors has largely taken a pathological approach. Researchers are increasingly taking a positive approach to explore adaptive eating styles. One such style that has recently received much research attention is intuitive eating. Recent work examining intuitive eating and its relationships with body mass and gender has yielded mixed findings. The current study explored the differential effects of gender and body mass on intuitive eating scores in a sample of Greek-Cypriot adults. Method: A total of 1,312 adult participants (women n = 655; M age = 34.49) completed the Intuitive Eating Scale-2 and provided demographic information. Results: Our analyses revealed that men reported significantly higher intuitive eating scores than women. Body mass was significantly inversely associated with intuitive eating in both men and women. Additionally, a multivariate analysis of variance (MANOVA) indicated significant interaction effects between gender and body mass on intuitive eating. These interaction effects were explored for each of the four subscales of intuitive eating, identifying differential associations for intuitive eating and BMI between men and women. Discussion: Both gender and body mass are important factors which influence intuitive eating levels in Greek-Cypriot adults. Discussions of how these findings can inform future research, theory and practice are presented.

Psychometric properties of a Greek translation of the Intuitive Eating Scale-2 (IES-2) in adults from Cyprus.

The construct of intuitive eating is commonly assessed using the 23-item, 4-factor Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013). In this study, we assessed the psychometric properties of a novel Greek translation of the IES-2 in adults from Cyprus. In Study 1 (N = 626), an exploratory factor analysis indicated that the IES-2 should be conceptualized as consisting of six factors that showed complete invariance across women and men. Study 2 (N = 793), using exploratory structural equation modelling (ESEM) and beifactor analysis (B-ESEM), indicated that the 6-factor B-ESEM model had adequate fit and evidenced complete invariance across sex once the correlated uniqueness of negatively worded IES-2 items was accounted for. This final model evidenced adequate composite reliability, and a global G-factor evidenced adequate convergent, concurrent, and discriminant validity. In contrast, the IES-2 S-factors showed more equivocal patterns of validity, with some S-factors showing less-than-adequate associations with body image variables, self-esteem, symptoms of disordered eating, and fruit and vegetable intake. In general, these results provide satisfactory evidence of the psychometric properties of the Greek IES-2 in adults from Cyprus, but also suggest that models of IES-2 scores may vary across national or cultural contexts.

Healthy orthorexia vs orthorexia nervosa: associations with body appreciation, functionality appreciation, intuitive eating and embodiment.

PURPOSE: Current conceptualizations and measures of orthorexia nervosa may not be accurately distinguishing between the healthy vs pathological pursuit of a healthy diet, leading to very high prevalence rates and risking the pathologizing and stigmatizing of healthy eating more generally. Recent research has identified healthy orthorexia as a novel construct conceptually distinct from orthorexia nervosa, which represents the non-pathological pursuit of a healthy diet. In light of the strong body of evidence supporting the role of positive body image in eating behavior, the current study aimed to examine the associations between healthy orthorexia, orthorexia nervosa, intuitive eating and indices of positive body image. METHODS: The current study employed a cross-sectional design. An online community sample (N = 835; 62% women; Mage = 40.24, SD = 14.45) completed self-report questionnaires including the Teruel Orthorexia Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Intuitive Eating Scale-2, and Experience of Embodiment Scale. RESULTS: Intuitive eating and indices of positive body image were significantly positively associated with healthy orthorexia and inversely associated with orthorexia nervosa. A hierarchical multiple regression analysis found that intuitive eating and indices of body image were uniquely associated with 13.3% of the variance of healthy orthorexia above and beyond that accounted for by orthorexia nervosa. Intuitive eating moderated the relationship between healthy orthorexia and orthorexia nervosa. CONCLUSION: The findings of this study provide support for intuitive eating and indices of positive body image as worthy of further exploration as important factors which distinguish between healthy orthorexia and orthorexia nervosa. LEVEL OF EVIDENCE: V, descriptive study.

Translation and validation of the Greek version of the Modified Weight Bias Internalization Scale in an adult population.

Weight bias internalization (WBI) has been identified as a global public health concern, which is associated with significant psychological and physical consequences. Despite increased interest in WBI worldwide, cross-cultural research is limited by the lack of availability of validated measures. The aim of the current study was therefore to translate into Greek and validate the Modified Weight Bias Internalization Scale (WBIS-M), the most widely used instrument in the measurement of WBI. An online convenience sample of 642 participants (364 women and 278 men) completed the Greek translation of the WBIS-M and validated the measures of satisfaction with appearance, investment in appearance, weight/appearance anxiety, body appreciation, dysfunctional eating habits and global self-esteem to assess convergent validity. Principal factor and confirmatory analyses revealed that the WBIS-M upheld its one-factor structure. The WBIS-M showed adequate internal consistency, convergent validity and 3-week test-retest reliability. These findings provide support for the cross-cultural equivalence of the WBIS-M and for the utility of this measure in Greek-speaking populations.

Risk and Protective Factors of Disordered Eating in Adolescents Based on Gender and Body Mass Index.

The current study aimed to identify potential psychosocial risk and protective factors contributing to eating disorders in adolescents, and observe any differences between genders and Body Mass Index (BMI) categories. A cross-sectional survey was carried out with a total of 2605 (1063 male) adolescents, who were assessed for disordered eating, body-image satisfaction and investment, appearance/weight-related anxiety, situational dysphoria, media influences, self-esteem, and body appreciation. The results revealed that weight/appearance-related anxiety and situational dysphoria were the most significant risk factors for both genders. Pressures from the media posed a significant risk only for males and the internalization of the thin ideal only for females; however, the internalization of the athletic ideal did not pose as a significant risk factor. Compared to gender, these risk factors did not differ based on BMI. Additionally, body appreciation was found to be a robust protective factor (unlike global self-esteem) for both genders, and across all BMI groups. The findings indicate that the most significant risk and protective factors of eating disorders do not differ largely for male and female adolescents or different BMIs. Intervention and prevention programs would therefore benefit from the inclusion of exercises that reduce the constructs of weight/appearance-related anxiety and situational dysphoria, and promote body appreciation.