Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: results of the Gender and Body Image (GABI) study

A comprehensive investigation of the association between menopause symptoms and problematic eating behavior in peri- and post-menopause cisgender women

Midlife individuals assigned female at birth are at risk for problematic eating behavior, associated with negative health outcomes. Little is known about how menopausal symptoms may increase risk in this population. The current study aimed to understand how a comprehensive range of menopause symptoms were globally associated with problematic eating behaviors. A total of 281 cisgender women (176 post-menopause, 105 peri-menopause) from the United States aged 40 to 64 were recruited utilizing Prolific, an online survey platform. Participants answered questionnaires about menopause symptoms and problematic eating. Participants were selected using demographic and health information provided in a screener survey. Participants also completed the Eating Disorder Questionnaire (EDE-Q), Women's Health Questionnaire (WHQ), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), and Pittsburgh Sleep Quality Index (PSQI). Using Structural Equation Modeling, menopause symptoms explained 16.7 percent of the variance in problematic eating. Higher frequency and severity of anxiety, depression, sleep concerns, cognitive complaints, pain, and vasomotor symptoms was associated with greater frequency and severity of problematic eating behaviors, β = .40, p < .001. Invariance testing showed no significant differences between peri- and postmenopausal women. These findings support the association between menopause symptoms and problematic eating in Midlife cisgender women and highlight the need for continued investigation.

Dissatisfaction with body image and weight gain in middle-aged women: A cross sectional study

OBJECTIVES

To investigate the relationship between weight gain and body image perception in in middle-aged women.

METHODS

Cross-sectional study with 453 women. Body image was assessed using the Stunkard scale, in which women were classified as: satisfied or dissatisfied (general, thinness or obesity). The identification of possible factors associated with body image dissatisfaction was performed using binary logistic regression analysis.

RESULTS

The mean age was 55.7 (±9.6) years; 80.8% were classified as dissatisfied with body image. As for body composition, women satisfied with their body image had lower values of body fat and higher values of lean mass. In the logistic regression, for general dissatisfaction and obesity, the associated variables were BMI, education and physical activity. As for "dissatisfaction with thinness", only BMI was associated.

CONCLUSION

Thus, the prevalence of body image dissatisfaction is high in women and part of associated factors are linked to lifestyle behaviors.

The Longitudinal Associations of Body Dissatisfaction with Health and Wellness Behaviors in Midlife and Older Women

Emerging research suggests that body dissatisfaction (BD) is prevalent among midlife and older women (i.e., upwards of 70%). Cross-sectionally, BD is associated with myriad poor health and wellness outcomes (e.g., depression, disordered eating, bad nutrition) in midlife/older women. However, relatively few studies have examined the longitudinal relations between BD and health outcomes in this population. This preliminary study investigated the longitudinal associations of BD with wellbeing and health-related quality of life (QOL) among midlife/older adult women over one year. Participants (n = 86, women aged 40-72 years, M = 51.49, SD = 7.34, 86% white) completed self-report measures of BD, psychosocial impairment, health behaviors, and QOL at baseline (T1) and 12-month follow-up (T2). A series of multiple linear regression models included T1 BD as the predictor variable of health outcomes at T2, covarying for T1 BMI and age in all models. BD was associated with greater negative emotions and psychosocial impairment, less physical activity enjoyment, and poorer physical, psychological, and social QOL one year later. Findings suggest that BD is associated with negative consequences for women across the lifespan (ƒ2 ranges = 0.06-0.60). Future research investigating BD as a unique, modifiable risk factor for health outcomes among diverse samples of midlife/older women is warranted. Targeting BD in interventions may improve health indices beyond eating disorders for this population.

Body image disturbance, interoceptive sensibility and the body schema across female adulthood: a pre-registered study

Introduction

Body image disturbance (BID) typically involves explicit negative attitudes toward one's shape and weight and is associated with altered interoceptive sensibility (the subjective perception of internal bodily states). This association is a known risk factor for the development and maintenance of eating disorders. However, while research has centred on younger women with eating disorders, diverse facets of BID appear in women without eating disorders across adulthood. Research shows that in the general population, young women (ages 18-25) with high BID exhibit disturbances in the body schema: an implicit sensorimotor representation of the body in space which includes mental simulation of a movement such as motor imagery. Given that body image is subject to age-related influences, it is important to investigate how age-related variation in BID can influence the body schema beyond young adulthood alone. Here, we examine the relationship between BID, interoceptive sensibility and the body schema across female adulthood.

Methods

Cross-sectional data was collected online from 1,214 women across four age groups: Young adults (18-24), Adults (25-39), Middle-aged adults (40-59), and Older aged adults (60-75). BID was indexed by questionnaires measuring body objectification, state, and trait body dissatisfaction. Interoceptive sensibility (IS) was measured using the MAIA-2 questionnaire. The body schema was evaluated through the Own Body Transformation task: a mental rotation task which assesses the capacity to make an embodied mental transformation.

Results

Analyses revealed that while body objectification and trait body dissatisfaction decreased from young to older adulthood, state body dissatisfaction showed a marked increase. A negative relationship between IS and BID across all age groups was also evidenced. Finally, age, BID and orientation of the presented body were significant predictors of the time taken to make an embodied transformation.

Discussion

These findings highlight the consistent relationship of BID and IS across age groups beyond young adulthood and demonstrate the varying importance of different aspects of BID as individuals age. We also evidence for the first time that disruptions in body image have the potential to impact implicit sensorimotor representations of the body even in women without eating disorders across female adulthood.

Update on the epidemiology and treatment of eating disorders among older people

PURPOSE OF REVIEW

We reviewed the recent literature on the epidemiology and treatment of eating disorders among middle-aged and older women and men.

RECENT FINDINGS

Recent studies show that among older female persons, the prevalence rates with full diagnoses of eating disorders based on DSM-IV or DSM-5 criteria are between 2.1 and 7.7%, and among older men less than 1%. These studies show that the prevalence of eating disorders decreases by age in women, but it does not get towards zero even in very high age. Middle age, with a peak around 50, is also a critical time for the occurrence of eating disorders in men. Women who reported severe menopausal symptoms showed more eating disorder pathology compared with those with low symptoms during menopausal transition.

SUMMARY

Eating disorders do occur in middle and older age of both sexes. Shame and stigmatization have decreased, and medical awareness and explicit assessment of eating behavior in all age groups have developed. What puberty is for eating disorders in adolescence and young age is menopausal transition for midlife women. Also in men, associations with hormonal disturbances are possible. Treatment approaches should consider treatment strategies tailored to older women and men, addressing the context of midlife and aging.

Body image and willingness to change it-A study of university students in Poland

The present study aimed to identify declared patterns of ideal appearance among students at selected higher education institutions in Poland. In the present study, we set out to identify the body image and the propensity to change it. In order to achieve the goal of the study, a nationwide survey was carried out using a voluntary diagnostic survey. A total of 810 respondents took part in the survey. The study was conducted using a custom-made self-designed survey questionnaire with an indirect interview technique via a web-based platform (CAWI). The study results indicate that women were far more eager to maintain an attractive appearance through dieting than men. Importantly, the respondents, both women and men, did not identify influencers as role models of attractive appearance. Results of the present survey reveal that attitudes towards one's physical appearance are diverse and influenced by the considered factors. The attributes that determined the perception of oneself as an attractive person included height, weight, and body build. Normal body weight is a key feature of an attractive appearance, according to the respondents; nevertheless, students show a higher tolerance for being overweight than for being underweight. Furthermore, preferences in this respect are largely conditioned by individual personal characteristics. According to young people, a person with an attractive appearance is one who eats and exercises regularly, and who does not fall into extremes in terms of their appearance. On the other hand, the fear of growing fat and losing one's attractive appearance was frequently indicated among the concerns over personal appearance. Only one in five respondents expressed complete satisfaction with how they looked, with men and those with a normal BMI significantly more likely to do so. Respondents expressed readiness to undertake a range of activities related to increased exercise regime, changes in their eating habits, or seeking assistance (e.g., of a personal trainer) to achieve the desired body shape. Our findings can be used as a basis for discussion and consideration in developing educational activities on nutrition, as well as on overweight- and obesity-related health issues.

Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression

BACKGROUND

International guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs.

METHODS

Retrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs.

RESULTS

1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP ("during" profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs.

CONCLUSIONS

Data extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.

Examining an integrated sociocultural and objectification model of thinness- and muscularity-oriented disordered eating in Chinese older men and women

OBJECTIVE

We tested an integrated model of three prominent theories of disordered eating (tripartite influence theory, objectification theory, and social comparison theory) in a sample of older Chinese men and women.

METHOD

Chinese older men (n = 270) and women (n = 160) completed questionnaires assessing the tripartite influence, objectification, and social comparison theories and thinness- and muscularity-oriented disordered eating. Two structural equation models were tested in Chinese older men and women.

RESULTS

The integrated model showed good model fit and described meaningful variance in thinness- and muscularity-oriented disordered eating in Chinese older men and women. Higher appearance pressures were uniquely related to higher muscularity-oriented disordered eating in men. Across both gender groups, higher thinness internalization was uniquely related to higher thinness- and muscularity-oriented disordered eating, and in women only, higher muscularity internalization was uniquely related to lower thinness-oriented disordered eating. In men, higher upward and downward body image comparisons were uniquely related to higher and lower, respectively, muscularity-oriented disordered eating. In women, higher upward body image comparisons were only uniquely related to higher muscularity-oriented disordered eating while higher downward body image comparisons were uniquely related to both outcomes. Higher body shame was uniquely related to higher thinness-oriented disordered eating across both groups and in men alone, higher body shame was also uniquely related to higher muscularity-oriented disordered eating.

DISCUSSION

Findings, which tested the integration of tripartite influence, objectification, and social comparison theories, inform the prevention and treatment of disordered eating in Chinese older populations.

PUBLIC SIGNIFICANCE

The present study is the first to describe theories of disordered eating (tripartite influence, objectification, and social comparison) in Chinese older adults. Findings suggested good model fit and the integrated models described meaningful variance in thinness- and muscularity-oriented disordered eating in Chinese older women and men. Findings extend existing theories of disordered eating and, pending further study, may inform theory-driven prevention and treatment approaches in Chinese older adults.

Discrepancies between media portrayals and actual demographics of eating disorders in TV and film: implications of representation

BACKGROUND

Media has a reputation for painting a narrow, simplistic, sensationalized portrait of eating disorders. There is little analysis of how film and TV portray eating disorders nor the implications of this representation. This study fills that gap by comparing demographics of US film and TV characters since the 1980s to actual population demographics of people with eating disorders.

METHODS

We compiled a dataset of TV and movie characters with eating disorders and categorized characters' gender, age, race/ethnicity, and sexual orientation. We narrowed the dataset to include only US media depictions to facilitate comparisons with empirical prevalence, resulting in a total of 66 characters over the period 1981 to 2022. We then compared the demographic characteristics of our sample to national statistics on eating disorder prevalence.

RESULTS

US media depictions of eating disorders overrepresented characters who were heterosexual (75.56%), White (84.85%), women (89.39%), and under age 30 (84.85%). This does not accurately reflect the populations experiencing eating disorders in the US.

CONCLUSIONS

Eating disorders have an image problem. TV and movies inaccurately portray them as primarily affecting heterosexual, White, women under age 30. Misrepresentation could fuel existing stigmas that inhibit individuals with eating disorders from seeking and receiving treatment. It could also perpetuate stereotypes that fuel misperceptions of the disease by medical providers, families, and policymakers. We recommend more accurate representation in the media to better reflect current demographics and increase awareness of the range of people who can experience eating disorders.

Health service utilization among women veterans who report eating disorder symptoms

OBJECTIVE

Describe health service utilization in women veterans with eating disorder symptoms and characterize the nature of mental health services received.

METHOD

Women veterans (N = 191) in a northeastern Veterans Health Administration region completed the Eating Disorders Examination Questionnaire. Health service utilization was then observed for 5 years across multiple domains (i.e., mental health, primary care, telephone consultations, emergency services); negative binomial or zero-inflated negative binomial regression models (mental health) estimated the relative impact of reported eating disorder symptoms on health service utilization.

RESULTS

After adjusting for the effects of age and body mass index, higher eating disorder symptoms were associated with higher primary care, mental health services, and telephone consultations. Eating disorder diagnoses were infrequent across the sample.

DISCUSSION

Women veterans with higher self-reported eating disorder symptoms evidence higher health service utilization across common healthcare domains. Encounter data suggest that eating disorder symptoms are rarely identified or clinically addressed by providers. Existing mental health visits may represent an opportunity for selective screening for eating disorder symptoms, particularly among women who evidence known risk factors.

PUBLIC SIGNIFICANCE

This study reveals that women veterans with higher levels of eating disorder symptoms (e.g., dietary restriction, poor body image) use more primary care, mental health, and telephone consultations than others, but may not receive services that target disordered eating. Opportunities may exist to better identify eating disorder symptoms in the context of existing mental health visits, or potentially to combine treatment for eating disorder symptoms into their mental health care.

Social media and disordered eating among middle-aged women: Not just an adolescent concern

Evidence suggests social media use is strongly linked to disordered eating (e.g., binge eating and dietary restraint) among adolescent and young adult women, in part because it promotes engagement in social comparison (the tendency to evaluate one's own standing or ability by comparing it to another's). Yet no study has examined the impact of social media use and comparison on disordered eating among middle-aged women. Participants (N = 347), ages 40-63, completed an online survey about their social media use, social comparison, and disordered eating (bulimic symptoms, dietary restraint, and broad eating pathology). Results indicated that 89 % (n = 310) of middle-aged women used social media in the past year. Most participants (n = 260; 75 %) used Facebook, and at least a quarter used Instagram or Pinterest. Approximately 65 % (n = 225) used social media at least daily. Controlling for age and body mass index, social media-specific social comparison was positively associated with bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001). Multiple regression models evaluating frequency of social media use and social media-specific social comparison together revealed that social comparison explained a significant amount of unique variance in bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001) above and beyond frequency of social media use. Instagram explained a significant proportion of variance of dietary restraint compared to other social media platforms (p = .001). Findings suggest a large percentage of middle-aged women frequently engage with some type of social media. Further, social media-specific social comparison, rather than frequency of social media use, may be driving disordered eating in this age group of women.

Twenty-year associations between disordered eating behaviors and sociodemographic features in a multiple cross-sectional sample

BACKGROUND

Disordered eating behaviors (DEB) impact on health and wellbeing worldwide. This study aimed to examine sociodemographic trends in the prevalence of DEB over 20 years in the Australian general population.

METHODS

Data were derived from five sequential cross-sectional surveys (1998, 2008, 2009, 2016 and 2017) with population-representative samples of adults and adolescents residing in South Australia (N = 15 075). DEBs investigated were objective binge eating (OBE), strict dieting/fasting, and purging. Sociodemographic data included gender, age, educational level, work and marital status, and residence.

RESULTS

OBE prevalence increased significantly. Strict dieting/fasting also increased from 1998 to 2008/9 but remained stable between 2008/9 and 2016/7. Purging prevalence did not change significantly over time. All survey years were associated with a significantly higher odds of OBE, and strict diet/fasting compared to 1998. Lower age, a higher Accessibility Remoteness Index of Australia (ARIA) score, higher body mass index (BMI), higher educational attainment, and not being in a married or de facto relationship were independently associated with greater adjusted odds for endorsing OBE. Younger age, female gender, and higher BMI were also independently associated with greater adjusted odds for endorsing strict dieting/fasting.

CONCLUSIONS

The increased prevalence of DEBs in various strata of Australian society has both public health and clinical implications. The results refute the stereotype that eating disorders (EDs) predominantly affect young women. They build impetus for future research on EDs among men and older individuals, with a view to developing tailored public health and clinical interventions for these populations.

Mirror, mirror, on the social media … WeChat Moments usage and negative body image among female college students: Evidence from ecological momentary assessment data

Negative body image is prevalent among women and may lead to physical and mental health problems. Social media-including China's most popular platform, WeChat Moments-aggregates multiple aspects of appearance-related pressure and therefore is an important risk factor for negative body image. The current study examines the relationship between WeChat Moments usage and body image among female college students and the mediating mechanism of body surveillance. A sample of 151 female college students completed a 7-day ecological momentary assessment (EMA), responded to three surveys per day, and provided a total of 2949 EMA responses. We used multilevel structural equation modeling (MSEM) to examine the hypothesized models at both the between- and within-individual levels. The results showed that both overall WeChat Moments usage and appearance-related exposure on WeChat Moments were inversely and indirectly related to body image through the mediating role of body surveillance at the between-individual level. However, both overall WeChat Moments usage and appearance-related exposure on WeChat Moments were positively and indirectly related to body image through body surveillance at the within-individual level. Our findings indicate that WeChat Moments usage is associated with college women's body image differently at the between- and within-individual level, and body surveillance serves as a crucial underlying mechanism.

The Clinical Phenotype of Binge Eating Disorder among Postmenopausal Women: A Pilot Study

Binge eating disorder (BED), a form of overnutrition, may impact healthy aging for postmenopausal women. In community samples, 12-26% of older women (ages 60+) engage in binge eating. In younger adults, BED is comorbid with physical and psychological morbidities. However, little is known regarding the clinical phenotype, including medical and psychiatric comorbidities, of BED in postmenopausal women. This pilot study sought to identify psychosomatic, cardiometabolic, body composition, and physical function characteristics of postmenopausal, older adult (age ≥60 years) women with BED. Participants (N = 21, ages 60-75) completed a battery of physical assessments and surveys assessing psychosomatic health. Overall, 62% of women reported BE onset during peri- or post-menopause. Rates of comorbid depression, anxiety, sleep problems, and a history of severe menopausal symptoms were high. Cardiometabolic health was poor, and 42.9% met the criteria for metabolic syndrome. Additionally, 71.4% met the BMI criteria for obesity, and 40% of this sample met the criteria for sarcopenic obesity. Almost half of the sample presented with at least one mobility limitation; 85.7% had poor endurance. Evidence suggests that BED is highly comorbid with other chronic health conditions and may complicate treatment of these conditions, warranting further investigation and increased attention from healthcare providers serving postmenopausal women.

Eating disorder pathology in a sample of midlife and older adults experiencing food insecurity

Researchers have recently identified food insecurity (FI) as a risk factor for eating disorder pathology (EDP). Yet, associations between FI and EDP remain understudied in midlife and older adults. The current study is a descriptive and exploratory re-analysis of Becker et al. (2017, 2019), investigating prevalence rates of EDP and differences in EDP between midlife and older adult food bank clients. Additionally, we examined the relations between FI severity and EDP in each age group. Participants included 292 midlife (51-65 years) and 267 older adults (66+) who were clients of a local foodbank. All participants completed a self-report questionnaire inquiring about FI, EDP, and demographic information. Overall, 8.9 % of respondents had a probable eating disorder (10.5 % of midlife adults, 5.6 % of older adults). Binge eating was the most endorsed EDP. Significantly more midlife adults reported night eating and skipping ≥two meals in a row versus older adults. Additionally, FI severity level was associated with higher risk of night eating, BE, skipping ≥two meals in a row, and laxative use in midlife adults. These same associations were significant for older adults, with the addition of vomiting and exception of laxative use. Evidently, the relations between FI and EDP seen in younger populations extends into mid and late-life, with minimal differences between midlife and older adults living with FI. It is imperative that we intentionally include midlife and older adults in FI and EDP research, investigating how best to address disordered eating across the lifespan within the context of experiencing FI.

Network analysis of eating disorder symptoms in women in perimenopause and early postmenopause

OBJECTIVE

Eating disorders (EDs) are often stereotyped as disorders of adolescence and young adulthood; however, they can occur at any age. Prevalence of EDs at midlife are approximately 3.5% and specific symptoms at midlife can have prevalences as high as 29.3%. Studies also inconsistently suggest that EDs and related symptoms may be more prevalent in midlife aged women during perimenopause compared with midlife aged women at pre-menopause. To date few studies have examined the structure of and associations between ED symptoms in women specifically during perimenopause and early postmenopause. Thus, the purpose of the current study is to investigate the structure of ED symptoms specifically during perimenopause and early postmenopause.

METHODS

Participants included 36 participants (45-61 y old) in a larger clinical trial who completed the Eating Disorder Examination Questionnaire (EDE-Q) at a baseline study visit. Network analysis statistical models were used to examine the structure of and associations between ED symptoms assessed via the EDE-Q.

RESULTS

Shape dissatisfaction and weight dissatisfaction were the top 2 central symptoms in the network.

CONCLUSIONS

Results corroborate previous studies and indicate that, similar to young adult samples, dissatisfaction with body image is a core feature of ED pathology across the lifespan.

Positive body perception and its link to sexual satisfaction in aging women - findings from the Women 40+ Healthy Aging Study

Research on the relation between physical appearance and sexual satisfaction in aging women is scarce. This study uniquely links attractiveness, body perception, and sexual satisfaction in 124 healthy aging women. Two-thirds reported being highly sexually satisfied. BMI and fat mass correlated significantly with sexual satisfaction. Weight and shape concerns moderated this relationship, affecting sexual satisfaction beyond the effect of body size and composition. Given the "unattractive stereotype" of older women related to the enduring social beauty ideal of a youthful and thin body, positive body perceptions in light of age-associated bodily changes should be promoted.

Barriers and facilitators of intuitive eating in postmenopausal women: A qualitative study

This qualitative descriptive research explored barriers and facilitators of the intuitive eating (IE) implementation process, as experienced by six postmenopausal women classified as 'overweight' or 'obese'. The data was analysed using deductive and inductive thematic analysis and six themes were identified. IE implementation included developing scepticism about weight loss diets, dealing with hunger and satiety cues, making nutritious food choices for one's body, struggling with emotional eating, learning to accept one's body and challenging weight stigma and sociocultural norms of beauty and thinness. IE allowed women to develop a more peaceful relationship with their diet, and was accepted as a welcome alternative to dieting.

Binge Eating Risk During Midlife and the Menopausal Transition: Sensitivity to Ovarian Hormones as Potential Mechanisms of Risk

PURPOSE OF REVIEW

Recent research suggests that binge eating may be more prevalent among women in midlife than previously believed. The menopausal transition, an important developmental stage during midlife, is characterized by substantial fluctuations and eventual decreases in ovarian hormones that may contribute to increased risk. This narrative review summarizes findings from studies of binge eating during midlife and menopause and discusses the potential role of ovarian hormones in binge eating risk.

RECENT FINDINGS

Studies are few in number and findings are mixed, with only some studies showing increased binge eating during midlife and the menopausal transition. Sensitivity to ovarian hormones, potentially through gene x hormone interactions, may influence who experiences increased binge eating risk and could help explain mixed findings in the field. Future studies of hormone sensitivity and gene x hormone interactions are needed to further elucidate midlife and menopausal risk for binge eating in women.

The effects of prefrontal vs. parietal cortex transcranial direct current stimulation on craving, inhibition, and measures of self-esteem

While prefrontal cortex dysfunction has been implicated in high food cravings, other cortical regions, like the parietal cortex, are potentially also involved in regulating craving. This study explored the effects of stimulating the inferior parietal lobule (IPL) and dorsolateral prefrontal cortex (DLPFC) on food craving state and trait. Transcranial direct current stimulation (tDCS) was administered at 1.5 mA for 5 consecutive days. Participants received 20 min of IPL, DLPFC, or sham stimulation (SHAM) each day which consisted of two rounds of 10-min stimulation, divided by a 10-min mindfulness task break. In addition, we studied inhibition and subjective psychological aspects like body image and self-esteem state and trait. To decompose immediate and cumulative effects, we measured the following on days 1 and 5: inhibition through the Go/No-go task; and food craving, self-esteem, and body appreciation through a battery of questionnaires. We found that false alarm errors decreased in the participants receiving active stimulation in the DLPFC (DLPFC-group). In contrast, false alarm errors increased in participants receiving active stimulation in the IPL (IPL-group). At the same time, no change was found in the participants receiving SHAM (SHAM-group). There was a trending reduction in craving trait in all groups. Momentary craving was decreased in the DLPFC-group and increased in IPL-group, yet a statistical difference was not reached. According to time and baseline, self-esteem and body perception improved in the IPL-group. Furthermore, self-esteem trait significantly improved over time in the DLPFC-group and IPL-group. These preliminary results indicate that tDCS modulates inhibition in frontoparietal areas with opposite effects, enhancing it in DLPFC and impairing it in IPL. Moreover, craving is moderately linked to inhibition, self-esteem, and body appreciation which seem not to be affected by neuromodulation but may rely instead on broader regions as more complex constructs. Finally, the fractionated protocol can effectively influence inhibition with milder effects on other constructs.

What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding

Substantial progress has been made in the understanding of anorexia nervosa (AN) and eating disorder (ED) genetics through the efforts of large-scale collaborative consortia, yielding the first genome-wide significant loci, AN-associated genes, and insights into metabo-psychiatric underpinnings of the disorders. However, the translatability, generalizability, and reach of these insights are hampered by an overly narrow focus in our research. In particular, stereotypes, myths, assumptions and misconceptions have resulted in incomplete or incorrect understandings of ED presentations and trajectories, and exclusion of certain patient groups from our studies. In this review, we aim to counteract these historical imbalances. Taking as our starting point the Academy for Eating Disorders (AED) Truth #5 "Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses", we discuss what we do and do not know about the genetic underpinnings of EDs among people in each of these groups, and suggest strategies to design more inclusive studies. In the second half of our review, we outline broad strategic goals whereby ED researchers can expand the diversity, insights, and clinical translatability of their studies.

The effects of body-positive Instagram posts on body image in adult women

While recent studies have examined the effects of viewing body-positive social media content on body appreciation and satisfaction in young adult women, research has yet to include older adult women. The current study assessed the effects of viewing body-positive Instagram content on body image in 205 adult women (18-76 years old) who were randomly assigned to view either body-positive, thin-ideal, or appearance-neutral Instagram content. Our findings demonstrated that exposure to body-positive Instagram content resulted in greater levels of body appreciation and body satisfaction compared to exposure to thin-ideal and neutral Instagram content, while no significant differences were found between any of the conditions on self-objectification. Finally, age was only a significant moderator for one variable (self objectification) and condition (thin ideal), indicating that exposure to body-positive social media content may improve levels of body appreciation and satisfaction in adult women, regardless of age.

Body Satisfaction and Associated Predictors Among Baby Boomer Women in Rural and Urban Manitoba

Purpose: This study examines body satisfaction, weight attitudes, dieting behaviours, and aging concerns of baby boomer women (BBW; born 1946-1965) from rural and urban Manitoba.Methods: Primary data collection occurred November 2015, and 1083 participants completed the Body Image and Food Choice Survey. Four strata of BBW were represented to examine differences between older and younger BBW and location of residence. Multinomial logistic regression models were fit to determine predictors of weight and appearance satisfaction. Odds ratios and 95% confidence intervals were considered significant at p ≤ 0.05.Results: Fifty-three percent of participants were satisfied with their appearance, whereas only 34% were satisfied with their weight. Ninety-one percent desired to lose weight (29.9 ± 29.3 lbs). Aging anxiety was evident for 46% of participants and associated with appearance satisfaction (χ² = 27.46, df = 4, p < 0.001). Body work and dieting behaviours were used to mitigate body dissatisfaction, and media influence was associated with both appearance (χ² = 76.17, df = 6, p < 0.001) and weight satisfaction (χ² = 67.90, df = 6, p < 0.001). Desired weight change, appearance stress, appearance importance, and self-rated health predicted both weight and appearance satisfaction.Conclusions: There is a need for greater awareness of aging women's body image concerns and the need for age-appropriate tools/resources to help dietitians support women achieve a healthy body image.

The clinical significance of binge eating among older adult women: an investigation into health correlates, psychological wellbeing, and quality of life

BACKGROUND

One type of overnutrition, binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women. Yet, little is known about the clinical significance of this eating disorder pathology in older adults, especially in relation to health outcomes used in geriatrics, while controlling for associations with body mass index (BMI).

METHOD

Women (N = 227) aged 60-94 completed two measures of BE and health/wellness questionnaires online. We used multivariable analyses to compare women with Clinical-frequency BE (≥ weekly frequency), Subclinical-frequency BE (< weekly), and No BE on health/wellness outcomes controlling for BMI. We conducted partial correlations controlling for BMI to examine associations between BE severity and health indices.

RESULTS

Controlling for BMI, the Clinical-frequency BE group reported poorer health-related quality of life (physical function, role limitations due to both emotional and physical problems, vitality, emotional wellbeing, social function, and pain) and poorer psychological health (depression, body image) compared to both Subclinical-frequency BE and No BE. The Clinical-frequency BE group also reported poorer sleep, nutritious food consumption, general health, and positive affect compared to No BE. Associations between a separate measure of BE severity and health indices confirmed findings from group comparisons.

CONCLUSION

Weekly BE may offer a promising screening benchmark for identifying one type of overnutrition in older women that is associated with numerous indicators of poorer health, independent of the effects of BMI. More research is needed to understand risks for and consequences of BE unique to older adult women. Binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women and is associated with health problems in younger populations. Yet, little is known about how BE is related to other health problems in older adults. We compared health behaviors, physical health, health-related quality of life, and psychological health between older adult women who reported weekly or more frequent BE (i.e., Clinical BE), those with low frequency BE (i.e., Subclinical BE), and those with no BE, while accounting for BMI. Older women in the Clinical BE group reported poorer health-related quality of life, more depression symptoms, and worse body image compared to the Subclinical BE and No BE groups. Compared to the No BE group, the Clinical BE group also reported poorer sleep, less frequent consumption of nutritious foods, worse health, and less frequent positive emotions. Using a separate measure of BE severity, we found similar associations with these health outcomes. Engaging in weekly BE may represent one type of overnutrition behavior in older women that is associated with numerous indicators of poorer health. More research is needed to understand risks for and consequences of BE unique to older adult women.

Body image concerns and disordered eating among older women: Identifying variables of interest for integrated models

OBJECTIVE

Research focused on developing risk and protective models of body image concerns and disordered eating among older women is scant. Models including biological, psychological, and sociocultural elements may be useful explanatory frameworks in this group. Thus, the aim of this study was to conduct formative research exploring the constructs that form part of biopsychosocial models of body image concerns and disordered eating among older women.

METHOD

A sample of 184 women aged 60-75 years completed an online survey assessing media pressures, thin-ideal internalization, depression symptoms, weight and shape concerns, and disordered eating as well as positive reappraisal and acceptance of aging-related changes to appearance.

RESULTS

After the addition of two supplemental pathways, the model revealed good fit to the data. In the final model, age, depression, and media pressure were associated with media internalization, that was in turn associated with weight and shape concerns, and then disordered eating. Depression was also directly associated with both weight and shape concerns and disordered eating. The model varied across older women with high versus low levels of positive reappraisal and acceptance of aging-related changes to appearance. Specifically, among those high on this trait, the pathways between depression and thin-ideal internalization, and between weight and shape concerns and disordered eating were significantly weaker.

DISCUSSION

These findings support the usefulness of biopsychosocial models for grounding research on body image concerns and disordered eating among older women, and suggest positive reappraisal and acceptance of aging-related changes to appearance as a useful dimension to focus on.

Disordered eating symptoms in Austrian men of different ages in the context of fitness centers

PURPOSE

To assess eating behavior and associated factors in male fitness-center attendees.

METHODS

An anonymous questionnaire was administered to male fitness center members of Innsbruck (Austria), aged 18-80 years to assess socio-demographic features, weight history, sports activity, eating behavior including disordered eating based on the Eating Disorder Examination Questionnaire (EDE-Q) and DSM-5 key symptoms for eating disorders (anorexia nervosa, binge eating, bulimia nervosa, purging disorder) and body image. Three age groups (younger-middle-aged-older men) were compared regarding the variables described above.

RESULTS

A total of 307 men included displayed high rates of disordered eating as described by EDE-Q cutoff scores (5-11%) as well as by DSM-5 eating disorder symptoms (10%). While EDE-Q cutoff scores did not differentiate between the groups, the prevalences of DSM-5 eating disorder symptoms yielded significant differences indicating a clear decrease with increasing age. Binge eating and bulimic symptoms with excessive exercising as the purging method were the most often reported symptoms.

CONCLUSION

Although described as typically female, disordered eating does occur in male fitness-gym attendees across all ages. The older the men, the less prevalent are the symptoms. Awareness of disordered eating and possible negative effects need to be addressed for attendees and trainers of the gym.

LEVEL OF EVIDENCE

V-descriptive survey study.

Disorders of eating and body image during the menopausal transition: associations with menopausal stage and with menopausal symptomatology

OBJECTIVE

Recent reports from our laboratory and others suggest that the menopausal transition may represent a window of vulnerability for eating disorders in women. Here, we present new findings regarding this issue.

METHODS

We surveyed 230 women aged 40-60 years using an anonymous questionnaire focused on eating-disorder and body-image symptomatology. We then compared groups of respondents based on (a) menopausal stage as assessed by World Health Organization (WHO) criteria and (b) menopausal symptomatology as assessed by the Menopause Rating Scale (MRS).

RESULTS

WHO-defined menopausal stage (premenopausal, perimenopausal, and postmenopausal) showed no significant associations with eating and body-image measures. However, MRS scores showed strong associations with most measures of the Eating Disorder Examination Questionnaire, as well as with questions regarding satisfaction with body image. These associations remained little changed even when removing the four psychological items from the MRS score and examining only the association of the MRS somato-vegetative and urogenital items with these outcome variables.

DISCUSSION

Our data augment existing evidence that the menopausal transition may be associated with eating and body-image disturbances. However, reported menopausal stage, which is difficult to define reliably, may be less informative than menopausal symptoms as a predictor of disordered eating and associated symptoms.

LEVEL OF EVIDENCE

V-descriptive survey study.

Binge eating among older women: prevalence rates and health correlates across three independent samples

BACKGROUND

Emerging research indicates that binge eating (BE; consuming unusually large amounts of food in one siting while feeling a loss of control) is prevalent among older women. Yet, health correlates of BE in older adult populations are poorly understood. The original study aimed to investigate BE prevalence, frequency, and health correlates in a sample of older adult women. Based on results from this first study, we then sought to replicate findings in two additional samples of older adult women from separate studies.

METHOD

Using self-reported frequencies of BE from three separate samples of older women with very different demographics, we compared BE prevalence, frequency, and health correlates among older women. Study 1 (N = 185) includes data collected online (86% White; 59% overweight/obese status). Study 2 (N = 64) was conducted in person at a local food pantry (65% Hispanic; 47% household income < $10,000/year). Study 3 (N = 100) comprises data collected online (72% White; 50% Masters/Doctoral Degree).

RESULTS

Per DSM-5 frequency criterion of BE at least weekly, we found prevalence rates ranging from 19 to 26% across the three samples. Correlates of BE frequency included elevated negative mood, worry, BMI, and less nutritious food consumption.

CONCLUSIONS

Across three very different samples in terms of race/ethnicity, education, food security status, measurements, and sampling methodology, we found fairly consistent rates of self-reported BE at least weekly (19-26%). Results suggest that BE is related to negative health indices among older women and support the need for more research in this population.

Is there a difference in body size dissatisfaction between the patients with obesity seeking and not seeking treatment for obesity?

BACKGROUND

Various factors motivate people to undertake treatment for obesity. Among others they include health benefits, willingness to please others, and dissatisfaction with one's appearance. The present study aimed to assess body size dissatisfaction in patients with obesity seeking and not seeking treatment for obesity.

METHODS

Two-hundred-sixteen adult subjects (154 women, 62 men) including 80 people with BMI ≥ 30 kg/m2 starting treatment for obesity (BMI 35.7 ± 5.3 kg/m2) and 136 volunteers with obesity (BMI 34.7 ± 4.3 kg/m2) not seeking treatment for obesity, were enrolled. Body size satisfaction was assessed using the Figure Rating Scale adapted by Stunkard.

RESULTS

Patients with obesity starting obesity treatment had more often a high level of body size dissatisfaction than volunteers with obesity not seeking the treatment (p <  0.001). There was a significant difference in the distribution of body size dissatisfaction in women (p <  0.05), but not in men (p = 0.47).

CONCLUSION

Patients with obesity, especially women, seeking obesity treatment more often represent a high level of body size dissatisfaction than volunteers with obesity not seeking treatment for obesity. This implies the need for public health campaigns to address negative attitudes or misconceptions about obesity and its treatment. Placing more attention and emphasis on body size dissatisfaction in more vulnerable women with obesity may help to define personal motivations and goals, strengthen the doctor-patient relationship and better adapt therapeutic strategies.

Associations between weight/shape overvaluation, sociodemographic features and BMI: 10-year time trends

PURPOSE

To investigate the prevalence of overvaluation across sociodemographic features and weight status over time.

METHODS

The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed.

RESULTS

Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04-3.99; 2008/9: OR 1.74, CI 1.50-2.01; 2015/6: OR 1.54, CI 1.34-1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49-10.34; 2008/9: OR 2.22, CI 1.31-3.78; 2015/6: OR 2.09, CI 1.19-3.67), had left school (2015/6: OR 1.36, CI 1.14-1.63), and lived in the country (2015/6: OR 1.95, CI 1.69-2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001).

CONCLUSIONS

Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005-2016.

EVIDENCE-BASED MEDICINE

Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

A qualitative study exploring middle-aged women's experiences with yoga

The purpose of this study was to explore how yoga impacts body-related thoughts, feelings, perceptions and attitudes, well-being, and self-care behaviors in a sample of middle-aged women who regularly engage in yoga in their communities. The sample included 22 women; 10 self-identified as beginners or novices and 12 self-identified as experienced in yoga. Interpretive phenomenological analysis guided the data collection, analysis, and interpretation. Four key themes were identified around the topics of: supportive yoga environment, mindfulness, self-care behaviors, and body-related perceptions. Results highlight potential elements of yoga that can support positive body-related experiences in middle-aged women.

An exploratory examination of internalized weight stigma in a sample living with food insecurity

Internalized weight stigma (IWS) is associated with various health concerns, regardless of body size. One weakness of existing IWS research is that it largely lacks diverse study populations. One recent exception, however, found increasing IWS was associated with higher levels of food insecurity (FI) in a low-income, majority Latinx sample. Using the same sample (N = 530), the present study further explored levels of IWS as compared to documented (mostly White/European) samples; we also investigated IWS in relation to three dichotomous eating disorder (ED) outcomes (e.g., any/no vomiting). Finally, based on previous qualitative findings regarding dietary restraint in the most severe level of FI, we explored the independent contribution of dietary restraint and IWS to cross-sectional risk of ED pathology. Results indicated that individuals living with FI experience IWS at concerning levels. Additionally, IWS played a small yet significant role in cross-sectional risk for ED pathology regardless of FI severity, while dietary restraint contributed to independent risk only in those with the most severe FI. Findings suggest that IWS is prevalent in this marginalized population, associated with ED pathology, and that the effect of dietary restraint on risk for ED pathology appears to uniquely impact those living with severe FI.

Diet quality in middle-aged and older women with and without body weight dissatisfaction: results from a population-based national nutrition survey in Switzerland

Body weight dissatisfaction is associated with unhealthy dietary behaviours in young adults, but data are scarce regarding how this relationship evolves with age. The objectives of the present study were to assess the prevalence of body weight dissatisfaction and the association between body weight dissatisfaction, nutrient intake and diet quality in middle-aged and older women. We used data of a population-based sample of 468 middle-aged (50–64 y/o) and older (65–75 y/o) women, extracted from the cross-sectional 2014–15 Swiss National Nutrition Survey. Body weight dissatisfaction was assessed by questionnaire. Dietitians assessed dietary intakes using two non-consecutive computer-assisted multi-pass 24-h dietary recalls and performed anthropometric measurements. Nutrient intakes were calculated and compared with national dietary guidelines, and diet quality scored with the 2010 Alternate Healthy Eating Index (2010-AHEI). 41⋅1 % of women reported body weight dissatisfaction, and 49⋅8 % wanted to lose weight. Body weight dissatisfaction was associated with weight loss desire and a higher body mass index (BMI; P < 0⋅001). Women with body weight dissatisfaction consumed significantly less carbohydrates and dietary fibres, even when BMI was controlled for (P < 0⋅05). They also fell short of national dietary guidelines for magnesium and iron. Body weight dissatisfied women obtained lower 2010-AHEI scores than satisfied women (β −4⋅36, 95 % CI −6⋅78, −1⋅93). However, this association disappeared when the BMI was introduced in the equation. This highlights the importance of targeting both body dissatisfaction and unhealthy eating in obesity prevention and treatment at all ages.

Weight regulation in menopause

IMPORTANCE AND OBJECTIVE

Obesity is a chronic disease of epidemic proportions that continues to affect millions of Americans each year. Postmenopausal women are particularly affected by obesity and have higher rates of severe obesity when compared with their male counterparts. The prevalence of obesity in this population is linked to increased morbidity and mortality and promotes the development and progression of numerous obesity-related health conditions. This review examines the epidemiology, pathophysiology, clinical assessment, and treatment of postmenopausal women with obesity.

METHODS

We have reviewed relevant and up-to-date literature in the MEDLINE database to represent the current understanding of obesity and its effects in this patient population. Articles published between the years 2000 and 2020 were selected for review to represent the most up-to-date evidence on the topic. Search terms used in the PubMed search included women, obesity, menopause, aging, mid-age women, metabolism, weight gain, treatment of obesity, weight loss, bariatric surgery, weight loss medications, diet, physical activity, and behavior modification.

DISCUSSION AND CONCLUSION

Obesity is a complex, chronic, relapsing disease that requires comprehensive assessment and treatment. Obesity is linked to hormonal, lifestyle, and environmental changes that occur during the menopausal transition, and it increases the risk for cardiometabolic disease. The utilization of appropriate clinical evaluation methods to identify obesity in postmenopausal women, and the implementation of effective lifestyle, pharmacotherapeutic, and surgical interventions, have the propensity to reduce the deleterious effects of obesity in this population.

The Effects of Self-Compassion and Self-Esteem Writing Interventions on Women’s Valuation of Weight Management Goals, Body Appreciation, and Eating Behaviors

In this study, we examined the effects of body-focused daily self-compassion and self-esteem expressive writing activities on women’s valuation of weight management goals, body appreciation, bulimic symptoms, and healthy and unhealthy eating behaviors. One-hundred twenty-six women, recruited from the community and a university participant pool ( Mage = 29.3, SD = 13.6), were randomly allocated to one of the three writing conditions: body-focused self-compassion, body-focused self-esteem, or control. Women reflected on a moment within the past 24 hours that made them feel self-conscious about their bodies, eating, or exercise habits (self-compassion and self-esteem conditions) or on a particular situation or feeling that occurred in the past 24 hours (control condition) for 4–7 days. At post-treatment (24 hours after the intervention), women in the self-compassion group demonstrated decreased bulimic symptoms, while women in the self-esteem and control conditions did not. Furthermore, clinically significant changes in bulimic symptoms were associated with being in the self-compassion condition but not in the self-esteem or control conditions. Results suggest that body-focused writing interventions may be more effective in temporarily reducing eating disorder symptoms in women if they focus on harnessing self-compassion. Additional online materials for this article are available on PWQ ’s website at http://journals.sagepub.com/doi/suppl/10.1177/03616843211013465

Body image concerns and intuitive eating in older women

Intuitive eating has been described as representing a positive relationship with food that can support health. However, to date, most of the extant research on intuitive eating has been conducted among young women, limiting our understanding of how intuitive eating can contribute to supporting health in aging women. This study aimed to bridge this gap by exploring body image and eating correlates of intuitive eating in older women. The hypotheses were that among older women, intuitive eating would be significantly associated with lower disordered eating, weight and shape concerns, and fewer depressive symptoms, and that an indirect relationship between BMI and intuitive eating via weight and shape concerns would exist. Community women aged 60-75 (N = 200) completed questionnaires assessing intuitive eating, disordered eating, body concern, depressive symptoms and body mass index (BMI). Higher intuitive eating global scores were associated with lower restraint, lower eating concern, lower body concern, fewer depressive symptoms, and lower BMI. An indirect relationship between BMI and intuitive eating via weight and shape concern emerged, suggesting that being preoccupied by one's appearance hinder the ability to practice intuitive eating. These results suggest that intuitive eating is associated with positive outcomes among older women and might be a useful target for interventions designed to increase healthy aging.

Tailoring a dissonance-based body image intervention for adult women in a proof of concept trial: The Women's Body Initiative

Although historically conceptualized as problems of youth, recent research indicates that women of all ages experience body dissatisfaction and eating disorder (ED) pathology. Despite this, existing body image interventions predominantly target youth. The Body Project (BP) has extensive support for reducing ED risk factors in younger women and girls. The current proof-of-concept study investigated the feasibility, acceptability, and estimates of intervention effect sizes of a modified BP for adult women, the Women's Body Initiative (WBI). Conducted in the Southwestern United States, adult women (N = 13) aged 29-70 (M = 49.1) participated in 4, 1-h weekly sessions, completing measures at baseline, post-intervention, and 3-month follow-up. Participants rated the program as highly feasible and acceptable. Within-subjects effects sizes were medium to large for primary outcomes (body dissatisfaction, ED pathology) and secondary outcomes (psychosocial impairment, negative affect, quality of life, nutritious food consumption, and sleep) through 3-months. Results suggest preliminary feasibility and acceptability of WBI for adult women, and support proceeding with a larger trial to investigate intervention efficacy.

Comparing eating disorder characteristics and treatment in self-identified competitive athletes and non-athletes from the National Eating Disorders Association online screening tool

OBJECTIVE

We compared eating disorder (ED) characteristics and treatment seeking behaviors between self-identified competitive athletes and non-athletes in a large, community-based sample.

METHOD

During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment.

RESULTS

The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non-athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge-eating episodes compared with non-athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non-athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non-athletes emerged on treatment history or intention to seek treatment post-screen (less than 30%).

DISCUSSION

Although the distribution of probable ED diagnoses was similar in athletes and non-athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport-specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.

Dissemination of a dissonance-based body image promotion program in church settings: A preliminary controlled pilot study with adult women

Adult women report significant body dissatisfaction yet are often overlooked in body image promotion programs. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many in the South of the United States. This study tested a dissonance-based body image program, Reclaiming Beauty (RB), adapted for adult women in church settings. Six groups (n = 30) were led by two trained church leaders (peer-led) and three groups (n = 21) were led by a trained peer leader and a researcher (researcher-co-led). RB participants, aged 30-77 years (M = 53.1 ± 12.7), completed assessments pre-intervention, immediately post-intervention, and 6 months post-intervention. Waitlist-controls (n = 31) completed assessments at time intervals consistent with intervention participants. RB participants reported significantly decreased thin-ideal internalization, body surveillance, and eating psychopathology at post-intervention and at 6 months post-intervention relative to controls. RB participants also reported significantly increased body satisfaction immediately post-intervention relative to controls, but this was not significant at 6 months post-intervention. Peer-led groups outperformed researcher-co-led groups on body surveillance at 6 months, but RB conditions did not otherwise differ. Our findings provide preliminary support for the dissemination of a culturally-modified dissonance-based body image program to adult women in church settings.

Assessing for Eating Disorders: A Primer for Gastroenterologists

Eating disorders involve irregularities in eating behavior that may cause gastrointestinal (GI) symptoms. Consequently, many patients with eating disorders seek gastroenterological healthcare at some point in their illness, with many seeking this care even before they seek treatment for and/or diagnosed with their eating disorder. As such, the gastroenterology provider is in a unique position to identify, manage, and facilitate treatment for an eating disorder early in the course of the illness. Although assessing eating disorders is already a difficult task, the identification of eating disorders in patients with GI disease represents an even greater challenge. In particular, common GI symptoms, such as nausea, vomiting, and bloating, may disguise an eating disorder because these symptoms are often viewed as a sufficient impetus for dietary restriction and subsequent weight loss. In addition, the focus on identifying an organic etiology for the GI symptoms can distract providers from considering an eating disorder. During this prolonged diagnostic evaluation, the eating disorder can progress in severity and become more difficult to treat. Unfortunately, a misconception that hinders eating disorder detection is the notion that the rate or method of weight loss is associated with an eating disorder. Regardless of whether weight loss is slow or rapid, purposeful or accidental, eating disorder behaviors and thought patterns may be present. Unidentified eating disorders are not only dangerous in their own right but also can interfere with effective management of GI disease and its symptoms. As such, it is imperative for the GI provider to remain well versed in the identification of these diseases.

Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa

Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.

Body image and disordered eating in older women: A Tripartite Sociocultural model

Evidence suggests that body image concerns and disordered eating exist in women even at older ages. Few studies have examined the factors that are related with body image and eating concerns in this age group. In particular, the roles of sociocultural influences and thin-ideal internalization remain unclear. In the present study, we tested a modified tripartite sociocultural model of body image and disordered eating behaviors in a sample of 222 women aged 60 to 75 years, using structural equation modeling. After adjustment, a model similar to that observed in young women was a good fit to the data. Perceived pressure from the media revealed a direct relationship with body image concerns, as well as an indirect relationship mediated by thin-ideal internalization. Peer pressure was directly associated with body image concerns, and thin-ideal internalization was associated with dieting. In older women, pressure to conform to appearance ideals, in particular from the media, may impact the internalization of appearance ideals and body image concerns that might, in turn, increase disordered eating. The usefulness of sociocultural models for framing body image and eating concerns in older women implies that similar prevention interventions to those used in younger women could be adapted to fill a gap in available resources for this group.

Factors associated with disordered eating behaviors and attitudes in older women

PURPOSE

The present study explored the potential factors associated with disordered eating behaviors and attitudes in older women.

METHODS

Women aged 60-75 years were recruited in the community (n = 203) and completed questionnaires. The Eating Disorder Examination-Questionnaire (EDE-Q) was used to evaluate disordered eating behaviors and attitudes. The independent variables were BMI, age, importance of appearance, importance of body competence, cognitive reappraisal, and fear of age-related appearance changes. Spearman correlation analyses and zero-inflated negative binomial regression models were used to analyze the data.

RESULTS

BMI was positively associated with EDE-Q restraint, EDE-Q eating concern, and EDE-Q frequency of objective binge-eating episodes. Importance of appearance was positively related to EDE-Q restraint, and fear of age-related appearance changes to EDE-Q eating concern and objective binge-eating episodes. Cognitive reappraisal was negatively associated with EDE-Q eating concern and excessive exercise in bivariate associations, but the relationships disappeared in the multivariate analyses.

CONCLUSIONS

BMI, importance of appearance, and fear of age-related appearance changes turned out to be positively associated with eating disordered behaviors and attitudes, similarly to what can be observed in middle-aged samples. However, the role of cognitive reappraisal was unclear and should be investigated further.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

How do you feel when you check your body? Emotional states during a body-checking episode in normal-weight females

PURPOSE

Cognitive-behavioral theories posit that body checking decreases negative emotions, but increases levels of arousal. However, few studies have investigated the effects of body checking on the course of emotional states. Therefore, the current study examined how normal-weight females with higher and lower eating, weight, and shape concerns feel during a checking episode of their most-liked and least-liked body parts.

METHODS

In an online design, levels of negative emotions and arousal were retrospectively assessed before, during, immediately after, and 15 min after an individually remembered body-checking episode. Participants (N = 355) also rated their subjective satisfaction with specific body parts.

RESULTS

Levels of negative emotions were lower 15 min after the checking episode of most-liked and least-liked body parts than before the episode. However, negative emotions increased during the checking episode of least-liked body parts, but subsided thereafter. The levels of arousal increased during the checking episodes of most-liked and least-liked body parts and decreased afterwards, and females with higher concerns reported greater levels of arousal than females with lower concerns. Furthermore, females with higher concerns reported more body checking than those with lower concerns.

CONCLUSIONS

The results support the assumptions of the cognitive-behavioral theories, as body checking led to a decrease in negative emotions in the longer term, and levels of arousal increased during the checking episode. The greater levels of arousal in females with higher concerns, and their pronounced body-checking behavior, might enhance their existing concerns and increase the risk of disordered eating.

LEVEL OF EVIDENCE

Level V, descriptive study.

Cross-cultural differences in orthorexic eating behaviors: Associations with personality traits

OBJECTIVES

Sociocultural factors and personality traits play key roles in determining dietary behaviors. Orthorexia nervosa (ON), the pathologic obsession with healthy eating, is increasingly receiving scientific attention. However, mechanisms and risk factors are not completely understood. The aims of this study were to compare the prevalence of orthorexic eating attitudes among adults in Germany and Lebanon, and to examine the relationship with primary facets of personality and maladaptive personality traits.

METHODS

The German sample comprised 391 adults, of which 314 were women (80.3%) and the mean age was 27 y. The Lebanese sample comprised 519 adults, of which 283 were women (56%) and the mean age was 36 y. In addition to sociodemographic data, participants completed the Dusseldorf Orthorexia Scale (DOS), the Teruel Orthorexia Scale (TOS), the Big Five Inventory, and the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.

RESULTS

Generally higher levels of healthy orthorexia among women and higher levels of ON according to the TOS-ON and DOS scores were found in Lebanon. In the Lebanese sample, 8.4% presented a high risk for ON, whereas this was true for only 4.9% of the German sample. Some associations between DOS/TOS scores and personality traits appeared but coefficients were generally low. Hierarchical multiple regression showed that the negative association between ON and the traits agreeableness and negative affectivity was clearly evident in the Lebanese sample but less so in the German sample. Age, body mass index, marital status, and subjective social status were not relevant moderators of effects. Comparison by country indicated higher prevalence of pathologic healthful eating and ON in the Lebanese sample compared with the German group. Personality traits, but not sociodemographic variables, partly contributed to this difference.

CONCLUSION

The present results suggested the importance of sociocultural factors in the development of eating pathologies and proposed specific personality traits as important associated factors.

Honey, Do I Look Fat? Perceptions of Spouses' Weight and Weight Concerns Predict Marital Relationship Quality

The majority of adults in the United States are overweight or obese, and yet Western ideals of beauty mean that low body fat composition is a component of physical attractiveness. In turn, perceived discrepancies between actual and ideal body shape and weight mean that many adults experience weight concerns-- and they also may be dissatisfied with their spouse's weight. This study examined whether weight concerns were linked to romantic relationship quality, an important domain of adult development. Specifically, we applied the Actor-Partner Interdependence Model to test how wives' and husbands' weight concerns and perceptions of their spouses' overweight contributed to their own and their spouse's reports of marital satisfaction and conflict over time. The sample was 197 heterosexual married couples (M age = 40.85 and 42.81 years for wives and husbands, respectively; M length of marriage = 18.6 years at Time 1) with children, who participated in a short-term longitudinal study of family relationships and adolescent development. Two-way interactions between partner perceptions of spouses' weight and gender indicated that husbands' perceptions that their wives were overweight predicted decreases in wives' marital satisfaction and increases in wives' reports of marital conflict across one year. In contrast, wives' perceptions of husbands' weight were not associated with changes in husbands' marital satisfaction or conflict. A two-way interaction between actor and partner weight concerns indicated that individuals reported more marital conflict when there was a discrepancy between their own and their spouse's weight concerns. Finally, a two-way interaction between actor and partner perceptions of spouse's weight indicated that, for individuals whose spouses rated them as below ideal weight, their perceptions of the spouse's overweight predicted their own lower marital satisfaction. Findings suggest that concerns about one's own and one's spouse's weight have negative ramifications for marital relationships.

Design and psychometric analysis of a climacteric adjustment questionnaire for middle-aged women

OBJECTIVE

The climacteric adjustment questionnaire (CAQ) was developed to assess the adjustment with fertility changes in middle-aged women. The aim of this study was to examine the psychometric properties of the CAQ in a sample of Iranian middle-aged women.

METHOD

This study used the impact item method and exploratory factor analysis (EFA) to evaluate the psychometric properties and construct validity of the developed questionnaire. The primary questionnaire was developed based on a qualitative study. A principal componential analysis (34 items) with Varimax rotation was conducted in a cross-sectional study on 277 middle-aged women.

RESULTS

In the qualitative section, of the 34 items extracted, those with an impact item index of over 1.5, a content validity ratio of over 0.42, and a content validity index of over 0.79 were considered as valid. EFA reduced the list of the items to 32 with six factors capable of predicting 58% of the variance. The Cronbach's α coefficient for CAQ was 0.863.

CONCLUSION

The findings of the present study indicated that the validity and reliability of the questionnaire designed to measure the adjustment to the climacteric period in middle-aged women could be used in related studies.

Body image in older women: a mediator of BMI and wellness behaviors

Negative body image is prevalent among mid- and late-life women. In younger women, negative body image is associated with reduced quality of life (QOL) when controlling for body mass index (BMI), and mediates the relationship between obesity and emotional wellbeing. Yet, much remains unknown about body image in older populations. In our sample of women aged 50-86 (N = 181), negative body image mediated the relationship between BMI and sleep, all four domains of QOL, negative affect, nutritious food consumption, and psychosocial impairment, but not enjoyment of physical activity. Findings suggest negative body image impacts the wellbeing of older women.

The prevalence and correlates of eating disorders in adult emergency department patients

OBJECTIVE

This study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders.

METHOD

Emergency department patients aged 21-65 years (n = 1,795) completed a computerized questionnaire that included validated screening tools for eating disorders, risky drinking behavior, other substance use, and depression. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, income, education), body mass index (BMI), risky drinking behavior, other substance use, and depression.

RESULTS

Nearly 16% (15.9%) of all patients screened positive for an eating disorder regardless of their reason for presenting to the emergency department. Patients who screened positive for an eating disorder were significantly more likely to have a BMI > 30 (odds ratio [OR] = 2.68, confidence interval [CI] = 1.98, 3.62, p < .001), to also screen positive for depression (OR = 3.19, CI = 2.28, 4.47, p < .001) and to be female (OR = 2.37, CI = 1.76, 3.19, p < .001). No differences in the prevalence of positive screens for eating disorders were seen across age or racial groups, level of education or income, or for any of the included substance use variables.

DISCUSSION

Eating disorders are common among adult emergency department patients and are associated with high rates of comorbid depression and higher BMI. Given the significant morbidity and mortality associated with eating disorders, targeted screening may be warranted in the emergency department setting.