Beyond BMI for self-estimates of body size and shape: A new method for developing stimuli correctly calibrated for body composition.

Accurate self-assessment of body shape and size plays a key role in the prevention, diagnosis, and treatment of both obesity and eating disorders. These chronic conditions cause significant health problems, reduced quality of life, and represent a major problem for health services. Variation in body shape depends on two aspects of composition: adiposity and muscularity. However, most self-assessment tools are unidimensional. They depict variation in adiposity only, typically quantified by the body mass index. This can lead to substantial, and clinically meaningful, errors in estimates of body shape and size. To solve this problem, we detail a method of creating biometrically valid body stimuli. We obtained high-resolution 3D body shape scans and composition measures from 397 volunteers (aged 18-45 years) and produced a statistical mapping between the two. This allowed us to create 3D computer-generated models of bodies, correctly calibrated for body composition (i.e., muscularity and adiposity). We show how these stimuli, whose shape changes are based on change in composition in two dimensions, can be used to match the body size and shape participants believe themselves to have, to the stimulus they see. We also show how multivariate multiple regression can be used to model shape change predicted by these 2D outcomes, so that participants' choices can be explained by their measured body composition together with other psychometric variables. Together, this approach should substantially improve the accuracy and precision with which self-assessments of body size and shape can be made in obese individuals and those suffering from eating disorders.

Fixation patterns, not clinical diagnosis, predict body size over-estimation in eating disordered women and healthy controls.

OBJECTIVE: A core feature of anorexia nervosa (AN) is an over-estimation of body size. Women with AN have a different pattern of eye-movements when judging bodies, but it is unclear whether this is specific to their diagnosis or whether it is found in anyone over-estimating body size. METHOD: To address this question, we compared the eye movement patterns from three participant groups while they carried out a body size estimation task: (i) 20 women with recovering/recovered anorexia (rAN) who had concerns about body shape and weight and who over-estimated body size, (ii) 20 healthy controls who had normative levels of concern about body shape and who estimated body size accurately (iii) 20 healthy controls who had normative levels of concern about body shape but who did over-estimate body size. RESULTS: Comparisons between the three groups showed that: (i) accurate body size estimators tended to look more in the waist region, and this was independent of clinical diagnosis; (ii) there is a pattern of looking at images of bodies, particularly viewing the upper parts of the torso and face, which is specific to participants with rAN but which is independent of accuracy in body size estimation. DISCUSSION: Since the over-estimating controls did not share the same body image concerns that women with rAN report, their over-estimation cannot be explained by attitudinal concerns about body shape and weight. These results suggest that a distributed fixation pattern is associated with over-estimation of body size and should be addressed in treatment programs. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:507-518).

A cluster randomised trial testing an intervention to improve parents' recognition of their child's weight status: study protocol.

BACKGROUND: Parents typically do not recognise their child's weight status accurately according to clinical criteria, and thus may not take appropriate action if their child is overweight. We developed a novel visual intervention designed to improve parental perceptions of child weight status according to clinical criteria for children aged 4-5 and 10-11 years. The Map Me intervention comprises age- and sex-specific body image scales of known body mass index and supporting information about the health risks of childhood overweight. DESIGN: This cluster randomised trial will test the effectiveness of the Map Me intervention. Primary schools will be randomised to: paper-based Map Me; web-based Map Me; no information (control). Parents of reception (4-5 years) and year 6 (10-11 years) children attending the schools will be recruited. The study will work with the National Child Measurement Programme which measures the height and weight of these year groups and provides feedback to parents about their child's weight status. Before receiving the feedback, parents will complete a questionnaire which includes assessment of their perception of their child's weight status and knowledge of the health consequences of childhood overweight. The control group will provide pre-intervention data with assessment soon after recruitment; the intervention groups will provide post-intervention data after access to Map Me for one month. The study will subsequently obtain the child height and weight measurements from the National Child Measurement Programme. Families will be followed-up by the study team at 12 months. The primary outcome is any difference in accuracy in parental perception of child weight status between pre-intervention and post-intervention at one month. The secondary outcomes include differences in parent knowledge, intention to change lifestyle behaviours and/or seek advice or support, perceived control, action planning, coping planning, and child weight status at 12 month follow-up. DISCUSSION: The Map Me tool has potential to make a positive impact on children's health at a population level by introducing it into current intervention programmes to improve accuracy of parental perception of child's weight status. This trial will inform the action of researchers, educators, health professionals and policy makers. TRIAL REGISTRATION: Current Controlled Trials ISRCTN91136472. Registered 3 May 2013.

Humans are not fooled by size illusions in attractiveness judgements.

Could signallers use size contrast illusions to dishonestly exaggerate their attractiveness to potential mates? Using composite photographs of women from three body mass index (BMI) categories designed to simulate small groups, we show that target women of medium size are judged as thinner when surrounded by larger women than when surrounded by thinner women. However, attractiveness judgements of the same target women were unaffected by this illusory change in BMI, despite small true differences in the BMIs of the target women themselves producing strong effects on attractiveness. Thus, in the context of mate choice decisions, the honesty of female body size as a signal of mate quality appears to have been maintained by the evolution of assessment strategies that are immune to size contrast illusions. Our results suggest that receiver psychology is more flexible than previously assumed, and that illusions are unlikely to drive the evolution of exploitative neighbour choice in human sexual displays.

Sample characteristics for quantitative analyses in Body Image: Issues of generalisability.

Psychological research frequently encounters criticism regarding the representativeness of the samples under study, highlighting concerns about the external validity of the obtained results. Here, we conducted a comprehensive survey of all the quantitative samples from the journal Body Image for 2021 (n = 149 samples). Our primary objective was to examine the extent to which the sampled populations deviated from the population at large, which could potentially compromise the generalizability of findings. We identified that a substantial number of these samples came from student populations (n = 44) and the majority were from the United States, United Kingdom, and Australia. Only a small number of samples (n = 9) employed direct measurements of body mass index (BMI), while the majority relied on self-reported data (n = 93). For a subset of samples in the journal, which were drawn from the general population, we compared whether these differed from population reference values in terms of age and BMI. Using Monte Carlo simulations, we found that samples tended to be younger and score lower on BMI than reference values obtained from the broader population. Samples drawn from female university students also tended to be lower on BMI than age-matched reference samples. We discuss the implications of our findings and make recommendations on sampling and inference. We conclude that a clearer specification of the parameters or conditions under which findings are expected to generalise has the potential to enhance the overall rigor and validity of this field of research.

Personal ideal, cultural ideal and optimal attractiveness: Are these constructs for body size and shape the same or different?

There has been an assumption in the literature that the three concepts of ideal body shape (personal ideal, cultural ideal, and the most attractive body shape) are effectively the same percept. To test this presumption, 554 participants completed either a between- or within-subjects condition using a matrix of 32 bodies varying in two dimensions: muscle and adiposity. Three separate groups of participants were recruited to the between-subjects design and made only one of these judgements, whilst participants in the within-subjects version completed all three of these judgments. These bodies are based on 3D scans of 221 women's bodies and so accurately represent the change in size and shape caused by changing body composition. The participants also completed a set of psychometric questionnaires to index the degree to which external concepts of body image have been internalised. The results show that in both conditions, all three judgements collapse onto the same average preferred body shape, with low adiposity and relatively high muscularity. However, this masked systematic differences in responses between personal ideals and the other body judgements, which may be explained by a difference in how information directly related to oneself is processed relative to more abstract third person judgements.

Testing the validity of online psychophysical measurement of body image perception.

This body image study tests the viability of transferring a complex psychophysical paradigm from a controlled in-person laboratory task to an online environment. 172 female participants made online judgements about their own body size when viewing images of computer-generated female bodies presented in either in front-view or at 45-degrees in a method of adjustment (MOA) paradigm. The results of these judgements were then compared to the results of two laboratory-based studies (with 96 and 40 female participants respectively) to establish three key findings. Firstly, the results show that the accuracy of online and in-lab estimates of body size are comparable, secondly that the same patterns of visual biases in judgements are shown both in-lab and online, and thirdly online data shows the same view-orientation advantage in accuracy in body size judgements as the laboratory studies. Thus, this study suggests that that online sampling potentially represents a rapid and accurate way of collecting reliable complex behavioural and perceptual data from a more diverse range of participants than is normally sampled in laboratory-based studies. It also offers the potential for designing stratified sampling strategies to construct a truly representative sample of a target population.

Adaptation and Validation of the MapMe Body Image Scales in Spanish Parents of Schoolchildren.

Childhood overweight and obesity is a worldwide problem and to treat it parents' detection has to be improved. The MapMe Body Image Scales (BIS) are a visual tool developed to improve parental perception of child weight in the United Kingdon (UK) based on British growth reference criteria. The aim of this study was to make a transcultural adaptation and validation of the MapMe BIS in Spain based on International Obesity Task Force (IOTF) cut offs A descriptive cross-sectional study was done. First, a translation and cultural adaptation was carried out. A total of 155 10-11-year-old children and their parents participated in this study. Children were measured to calculate their weight status, Body Mass Index (BMI), Body Fat Percentage (BFP) and Waist Circumference (WC), and their parents completed a purpose designed questionnaire about their perception and satisfaction of child's body weight status using the adapted BIS. Test-retest reliability, criterion validity and concurrent validity of the adapted BIS were analyzed. This study shows that the adapted MapMe BIS has good psychometric properties and is a suitable visual scale to assess parental perception of weight status in 10 and 11-year-old children in Spain.

Men's oppressive beliefs predict their breast size preferences in women.

Previous studies of men's breast size preferences have yielded equivocal findings, with studies variously indicating a preference for small, medium, or large breasts. Here, we examined the impact of men's oppressive beliefs in shaping their female breast size ideals. British White men from the community in London, England (N = 361) viewed figures of women that rotated in 360° and varied in breast size along five levels. They then rated the figure that they found most physically attractive and also completed measures assessing their sexist attitudes and tendency to objectify women. Results showed that medium breasts were rated most frequent as attractive (32.7 %), followed by large (24.4 %) and very large (19.1 %) breasts. Further analyses showed that men's preferences for larger female breasts were significantly associated with a greater tendency to be benevolently sexist, to objectify women, and to be hostile towards women. These results were discussed in relation to feminist theories, which postulate that beauty ideals and practices in contemporary societies serve to maintain the domination of one sex over the other.

How do looking patterns, anti-fat bias, and causal weight attributions relate to adults' judgements of child weight?

Prevailing weight-normative approaches to health pressure adults to visually categorise children's weight, despite little understanding of how such judgements are made. There is no evidence this strategy improves child health, and it may harm children with higher weights. To understand decision-making processes and identify potential mechanisms of harm we examined perceptual and attitudinal factors involved in adults' child weight category judgements. Eye movements of 42 adults were tracked while categorizing the weight of 40 computer-generated images of children (aged 4-5 & 10-11 years) varying in size. Questionnaires assessed child-focused weight bias and causal attributions for child weight. Participants' eye movement patterns resembled those previously reported for adult bodies. Categorisation data showed a perceptual bias towards the 'mid-range' category. For higher weight stimuli, participants whose category judgements most closely matched the stimulus's objective weight had higher child-focused anti-fat bias and weaker genetic attributions for child weight - i.e,. adults who 'label' higher weight in children in line with BMI categories report more stigmatising beliefs about such children, suggesting a possible mechanism of harm. Overall, adults' judgements reflect both unalterable perceptual biases and potentially harmful attitudinal factors, calling into question the feasibility and appropriateness of public health efforts to promote visual child weight categorisation.

Men's perception of current and ideal body composition and the influence of media internalization on body judgements.

Introduction: To determine men's body ideals and the factors that influence these choices, this study used a matrix of computer generated (CG) male bodies (based on an analysis of 3D scanned real bodies) which independently varied in fat and muscle content. Methods: Two hundred and fifty-eight male participants completed a range of psychometric measures to index body concerns and body ideal internalization and then chose the CG body that best reflected their own current body, as well as the body that reflected their personal ideal. A subset of participants was then retested to check that these judgements were stable over time. Results: While judgements of the ideal body seem to be influenced by a shared appearance ideal, the degree to which this ideal was internalized showed significant variability between participants. The effect of this internalization was reflected in the difference between the estimated current body and the ideal. Discussion: Higher internalization led to a preference for higher muscle and lower fat content. This preference was most marked for fat content, although reducing adiposity also made the underlying musculature more salient. Additionally, the ideal body composition was modulated by the composition the participant believed his current body had (i.e., it seemed that a participant's ideal body was anchored by what they believed to be their current body and what change was possible from this starting point).

A Randomised Control Trial Investigating the Efficacy of the MapMe Intervention on Parental Ability to Correctly Categorise Overweight in Their Child and the Impact on Child BMI Z-Score Change at 1 Year.

Research suggests parental ability to recognise when their child has overweight is limited. It is hypothesised that recognition of child overweight/obesity is fundamental to its prevention, acting as a potential barrier to parental action to improve their child's health-related behaviours and/or help seeking. The purpose of this study was to investigate the efficacy of an intervention (MapMe) to improve parental ability to correctly categorise their child as having overweight one-month post-intervention, and reduce child body mass index (BMI) z-score 12 months post-intervention. MapMe consists of body image scales of known child BMI and information on the consequences of childhood overweight, associated health-related behaviours and sources of support. We conducted a three-arm (paper-based MapMe, web-based MapMe and control) randomised control trial in fifteen English local authority areas with parents/guardians of 4-5- and 10-11-year-old children. Parental categorisation of child weight status was assessed using the question 'How would you describe your child's weight at the moment?' Response options were: underweight, healthy weight, overweight, and very overweight. Child weight status and BMI z-scores were calculated using objectively measured height and weight data and UK90 clinical thresholds. There was no difference in the percentage of parents correctly categorising their child as having overweight/very overweight (n = 264: 41% control, 48% web-based, and 43% paper-based, p = 0.646). BMI z-scores were significantly reduced for the intervention group at 12 months post-intervention compared to controls (n = 338, mean difference in BMI z-score change -0.11 (95% CI -0.202 to -0.020, p = 0.017). MapMe was associated with a decrease in BMI z-score 12 months post-intervention, although there was no direct evidence of improved parental ability to correctly categorise child overweight status. Further work is needed to replicate these findings in a larger sample of children, investigate mechanisms of action, and determine the use of MapMe as a public health initiative.

Further investigation of the validity and reliability of the photographic figure rating scale for body image assessment.

Previous studies have not fully investigated the psychometric properties of the Photographic Figure Rating Scale (PFRS). In 2 studies, we report on the test-retest reliability and convergent validity of ratings derived from the PFRS. In Study 1, 322 female university students in Britain provided self-ratings on the PFRS and objectively measured body mass index (BMI); a subsample of 132 women also completed the task after 5 weeks. In Study 2, 243 women from the community in Austria completed the PFRS along with a battery of other body image scales. Results of Study 1 showed that ratings on the PFRS had good test-retest reliability (all rs > .87) and good convergent validity in relation to BMI. Results of Study 2 showed that PFRS-derived body dissatisfaction scores were significantly correlated with a range of body image variables. These results provide evidence for the convergent validity and good test-retest reliability of the PFRS.

The Effect of Own Body Concerns on Judgments of Other Women's Body Size.

We investigated the relationships between healthy women's estimates of their own body size, their body dissatisfaction, and how they subjectively judge the transition from normal to overweight in other women's bodies (the "normal/overweight" boundary). We propose two complementary hypotheses. In the first, participants compare other women to an internalized Western "thin ideal," whose size reflects the observer's own body dissatisfaction. As dissatisfaction increases, so the size of their "thin ideal" reduces, predicting an inverse relationship between the "normal/overweight" boundary and participants' body dissatisfaction. Alternatively, participants judge the size of other women relative to the body size they believe they have. For this implicit or explicit social comparison, the participant selects a "normal/overweight" boundary that minimizes the chance of her making an upward social comparison. So, the "normal/overweight" boundary matches or is larger than her own body size. In an online study of 129 healthy women, we found that both opposing factors explain where women place the "normal/overweight" boundary. Increasing body dissatisfaction leads to slimmer judgments for the position of the "normal/overweight" boundary in the body mass index (BMI) spectrum. Whereas, increasing overestimation by the observer of their own body size shifts the "normal/overweight" boundary toward higher BMIs.

The degree to which the cultural ideal is internalized predicts judgments of male and female physical attractiveness.

We used attractiveness judgements as a proxy to visualize the ideal female and male body for male and female participants and investigated how individual differences in the internalization of cultural ideals influence these representations. In the first of two studies, male and female participants judged the attractiveness of 242 male and female computer-generated bodies which varied independently in muscle and adipose. This allowed us to map changes in attractiveness across the complete body composition space, revealing single peaks for the attractiveness of both men and women. In the second study, we asked our participants to choose the most attractive male and female bodies in a method of adjustment task in which they could independently vary muscle and adipose to create the most attractive body. We asked whether individual differences in internalization of cultural ideals, drive for muscularity, eating disorder symptomatology and depressive symptoms could systematically shift the location of peak attractiveness in body composition space. We found a clear preference by both genders for a male body with high muscle and low adipose, and a toned, low adipose female body. The degree of internalization of cultural ideals predicted large individual differences in the composition of the most attractive bodies.

Targeting body image in eating disorders.

Eating disorders, such as anorexia nervosa, are challenging to treat successfully and have a very high relapse rate. Body image disturbance (BID) is a core component of these eating disorders. It is a predictor of onset, treatment outcome and future relapse. However, recent studies suggest that BID can be improved by an adaptation of cognitive bias training. This does not target the accuracy of body size judgements, but instead focuses on how a body of a particular size is categorized by a patient. This recalibration of the categorical boundary at which bodies are judged as overweight, which challenges a patient's existing preconceptions about which constitutes an acceptable body size, seems to lead to a more general reassessment of eating disordered attitudes and a significant improvement in their psychological profile. These promising findings need further trials to determine the long-term effectiveness of such a targeted intervention, but it potentially provides an important additional treatment option. In addition, this cognitive bias training may also be an effective augmentation to treatment in other conditions that feature BID, such as bulimia nervosa and body dysmorphia.

Can realistic dolls protect body satisfaction in young girls?

Ultra-thin fashion dolls may represent a risk factor for thin-ideal internalisation and body dissatisfaction amongst young girls. We asked thirty one 5- to 9-year-old girls to engage in interactive play with commercially available dolls which were either ultra-thin (Barbie and Monster High) or represented a putative realistic childlike shape (Lottie and Dora) and to indicate their perceived own-body size and ideal body size on an interactive computer task both before and after play. There was a significant interaction between testing phase and doll group such that playing with the ultra-thin dolls led to the girls' 'ideal self' becoming thinner. A further 46 girls played with the ultra-thin dolls and then played with either the same dolls again, the realistic childlike dolls, or with cars. Initial play with the ultra-thin dolls again produced a drop in perceived ideal own body size; however, no group showed any significant change in their body ideals during the additional play phase. These data indicate the potential benefit of dolls representing a realistic child body mass to young girls' body satisfaction and do not support the hypothesis that the negative impacts of ultra-thin dolls can be directly countered by other toys.

Fat talk is predicted by body dissatisfaction and social comparison with no interaction effect: Evidence from two replication studies.

Verbal denigration of personal body size and shape ("fat talk") is correlated with, and can have a causal influence on body dissatisfaction and disordered eating. What is less clear is who is most likely to fat talk. To address this, Corning and Gondoli (2012) conducted a study confirming that a woman's body dissatisfaction directly predicted their fat talk. But this effect was scaled so that the likelihood of engaging in fat talk intensified if she had a stronger tendency to socially compare: the relationship was multiplicative. Here, we carried out two replications of Corning and Gondoli's (2012) study, the first with 189 UK participants and the second with 371 US participants. We found that multiple regression models predicting fat talk showed additive, but not multiplicative relationships. A robust Bayesian meta-analysis combining the results of our two studies with the results of the original study confirmed this. In conclusion, these studies show an additive relationship between fat talk and social comparison on fat talk.

The acceptability and feasibility of using a 3D body size scale to initiate conversations about weight in toddlerhood: a mixed-methods study.

BACKGROUND: Health Care Professionals struggle to initiate conversations about overweight in toddlerhood. A novel 3D body size scale (3D BSS) may facilitate engagement with this topic during pediatric appointments. OBJECTIVES: To explore barriers and facilitators to using the 3D BSS through a mixed-methods design. METHODS: For the qualitative phase, parents of toddlers (n = 38) participated in semi-structured interviews introducing the 3D BSS of 4-5-year-old children. For the quantitative phase, pre- and post-interview questionnaires were administered to ascertain the acceptability of the 3D BSS. RESULTS: Parents rated the 3D BSS as "very" (n = 20, 52.6%) to "moderately" (n = 12, 31.6%) acceptable. Thematic analysis revealed four barriers to acceptability: i) the sensitive nature of child weight, ii) the belief that weight does not determine health, iii) the visual normalisation of overweight and iv) the need to account for individual variation in growth patterns. However, these barriers could be overcome through three facilitators: i) the provision of expert guidance ii) the value of simple tools, and iii) tailoring conversations to familial needs. CONCLUSIONS: Parents considered the 3D BSS an acceptable visual resource to discuss child weight during routine appointments. However, the acceptability of the tool was conditional on a sensitive, collaborative, and tailored delivery approach.

3D visualisation of psychometric estimates for the ideal male body.

Psychological concerns are frequently indexed by psychometric questionnaires but the mental representations that they seek to quantify are difficult to visualise. We used a set of questionnaires designed to measure men's concept of their bodies including: the Drive for Muscularity Scale (DMS; McCreary & Sasse, 2000), the Perceived Sociocultural Pressures Scale (PSPS; Stice, Nemeroff, & Shaw, 1996a), the Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015), and the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004). We combined their use with an interactive 3D modelling programme to allow men to create computer-generated representations of their ideal bodies. We used a principal component analysis to extract those shape components of our participants' CGI ideal bodies that were predicted by the questionnaires and reconstructed the body shapes that these questionnaires were capturing. Moving from the lowest to the highest score on both the DMS and SATAQ corresponded with changes in muscularity, particularly muscle mass and definition. This approach allows us to demonstrate the actual body features that are being captured by a particular questionnaire.