A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders

A qualitative analysis of college women's experiences with dieting

OBJECTIVE

Dieting is a known risk factor for disordered eating, yet many college women engage in this behavior. Given the popularity of diets, and the risks associated with dieting, it is important to enhance understanding of dieters' experiences. This study utilized a qualitative approach to investigate college women's experiences of dieting.

PARTICIPANTS

Eighty-four woman-identifying undergraduates [42% White, 24% Asian, 20% Black, 14% other; Mage = 19.18 (1.77)] who endorsed dieting were included in the study.

METHODS

Participants provided short-answer responses to open-ended questions. Data were analyzed using a thematic analysis approach.

RESULTS

The following themes were identified: A complicated relationship, variability of experiences, and social factors. Subthemes highlighted the complexity of college women's dieting behavior.

CONCLUSIONS

Results provide important insight into college women's dieting experiences and their consequences. Future qualitative research should aim to understand how to apply these findings to eating disorder prevention efforts.

A brief mindfulness meditation can ameliorate the effects of exposure to idealised social media images on self-esteem, mood, and body appreciation in young women: An online randomised controlled experiment

The study examined whether a 10-minute mindfulness meditation intervention could ameliorate effects of exposure to social media thinspiration and fitspiration images on women's self-esteem, mood, and body appreciation. A total of 162 women aged 18-42 years (M = 25.94, SD = 4.38) completed an online experiment which involved viewing thinspiration and fitspiration images before random allocation to either a brief, ten-minute mindfulness meditation audio intervention or a ten-minute control audio about jujitsu. Participants completed self-reported measures of self-esteem, positive and negative mood, and body appreciation at baseline (Time 1), post-exposure to idealised social media images (Time 2), and immediately post-intervention (Time 3). Mixed, repeated-measures ANOVAs showed that scores were lower for body appreciation, self-esteem, and positive mood, and higher for negative mood, in both groups after exposure to idealised imagery. However, a brief mindfulness intervention ameliorated the negative effects of social media exposure. Specifically, self-esteem, body appreciation, and mood were higher in the mindfulness meditation group at Time 3, compared to the control group. Future interventions should explore the utility of mindfulness practices to provide long term buffering effects against such social media content, as well as targeting the idealisation of female physiques portrayed in thinspiration and fitspiration content.

Enhancing understanding of social media literacy to better inform prevention of body image and eating disorders

Research has revealed an important role for appearance-focused, and in particular photo-based, social media in the development of body image and eating pathology. Social media literacy is a multifaceted construct involving purposeful selection and exposure to social media content and use of protective filtering (deliberately screening and interpreting information in a protective manner), as well as implementing critical skills related to understanding the unrealistic nature of social media content, limiting appearance comparisons with images, and contributing to social media (comments and images) in ways that limit the pursuit of appearance ideals. Previous work has provided partial support for these facets as related to lower levels of body image and eating concerns. However, additional conceptual and measurement work is needed to advance understanding of this protective role and how to foster social media literacy. Although data are scarce, targeting social media literacy in prevention and intervention programs may also be valuable. In this perspective piece, key features that we identify as priorities for future prevention and intervention efforts include developing interventions that target the implementation of social media skills beyond their acquisition. In addition, leveraging social media user generated content for prevention purposes would likely be useful, as would embedding micro-skill delivery within platforms.

Appearance-based rejection sensitivity mediates the relationship between Instagram addiction and dysmorphic concerns in young adult women

INTRODUCTION

Dysmorphic concerns refer to excessive preoccupations with one's physical characteristics. There is a need to better understand the factors associated with these experiences, especially in young adult women. Given emergent research suggesting a link between the use of Instagram, dysmorphic concerns, and appearance pressures, we tested a mediation model in which appearance-based rejection sensitivity mediated the relationship between Instagram addiction and dysmorphic concerns.

METHODS

In this cross-sectional study, 300 young adult women from Romania with mean age of 22.19 years (SD = 2.07) and who possessed an Instagram account were asked to complete an online survey consisting of measures of dysmorphic concerns, Instagram addiction, and appearance-based rejection sensitivity.

RESULTS

Correlational analyses revealed that all three variables were positively and moderately inter-correlated. Mediation analysis supported the hypothesis that appearance-based rejection sensitivity mediates the relationship between Instagram addiction and dysmorphic concerns.

CONCLUSIONS

Implications of this study are discussed in terms of the urgency of prevention and intervention strategies, especially given the link between dysmorphic concerns and more extreme manifestations of severity, such as body dysmorphic disorder.

Strike a pose: Immediate effects of a model-created social media literacy video on body image and mood

Exposure to idealized social media imagery has been shown to be detrimental to body image among young women, and social media literacy may be protective. This mixed methods study aimed to evaluate the effects of an online video narrated by a high-profile, plus-size model on the body image and negative mood of young women and predictors of the effects. A sample of 304 young women, average age 20.95 (SD = 2.09) years, completed an online survey including pre- and post-exposure measures of state body image and negative mood, and trait measures of upward social media appearance comparison, thin-ideal internalization, and selfie-investment. A subset (n = 148) responded to open-ended questions to obtain feedback on the video coded categorically and through thematic analysis. Findings revealed immediate improvements in state body satisfaction and negative mood, with higher levels of trait appearance comparison and selfie investment associated with smaller effects of the video. Participants endorsed the video as raising awareness of unrealistic images but limited in terms of mitigating appearance comparison and selfie-investment. Furthermore, participants described that Iskra's status as a professional model also influenced their reactions. These findings highlight the importance of assessing for unintended paradoxical effects of social media literacy efforts and ensuring that such interventions are empirically based.

Validation of a Latin-American Spanish version of the Body Esteem Scale for Adolescents and Adults (BESAA-LA) in Colombian and Nicaraguan adults

BACKGROUND

Body dissatisfaction (BD) is a growing concern in Latin America; reliable and culturally appropriate scales are necessary to support body image research in Spanish speaking Latin American countries. We sought to validate a Latin-American Spanish version of the Body Esteem Scale for Adolescents and Adults (BESAA; Mendelson et al. 2001).

METHODS

The BESAA was translated, culturally adapted, and validated in a sample of adults in Colombia (N = 525, 65% women, Mage 24.4, SD = 9.28). We assessed factor structure (using confirmatory factor analysis (CFA), exploratory factor analysis (EFA) and exploratory structural equation model (ESEM)), internal reliability (using Cronbach's alpha and omega), validity (using the Body Appreciation Scale BAS and Sociocultural Attitudes Towards Appearance Questionnaire SATAQ), test-retest stability in a small subsample (N = 84, using Intraclass correlations ICC) and measurement invariance across gender. To evaluate the generalizability of the scale, we assessed reliability, validity, and factor structure in a second sample from rural Nicaragua (N = 102, 73% women, Mage 22.2, SD = 4.72), and assessed measurement invariance across Nicaraguan and Colombian participants.

RESULTS

The scale showed good internal reliability and validity in both samples, and there was evidence of adequate test-retest stability in the Colombian sample. EFA showed a three-factor structure with subscales we labelled 'appearance-positive', 'appearance-negative' and 'weight', that was confirmed using CFA and ESEM in the Colombian sample. Measurement invariance was confirmed across the Colombian and Nicaraguan samples, and across gender within the Colombian sample.

CONCLUSION

The Latin-American Spanish version of the BESAA (BESAA-LA) appears to be a psychometrically sound measure with good reliability, validity and invariance across gender and countries. These results support the use of this scale to measure body satisfaction/dissatisfaction in Latin American adult populations.

Appearance comparison on Instagram: The impact of fitspiration and transformation imagery on young women's body satisfaction

Fitspiration, or imagery of thin muscular individuals that displays their physiques while posing or exercising, is a popular type of content on Instagram which ostensibly exists to encourage individuals to engage in a healthy lifestyle. A subtype of fitspiration imagery, "transformation" imagery, depicts physical changes following a "lifestyle change" involving diet and exercise. Despite its intentions, fitspiration imagery largely promotes one idealized body type (the fit ideal) and can be accompanied by messages encouraging restrained eating. Viewing fitspiration imagery has been associated with body dissatisfaction and appearance comparison in women, but the impact of transformation imagery specifically on women's body image has not yet been studied, nor has the impact of the broader fitspiration category and the transformation subtype on women's body image been compared. The current study aimed to clarify the relations between fitspiration and transformation imagery, appearance comparison, and body satisfaction using an experimental design. Female participants (N = 161) completed a measure of body satisfaction and then were randomly assigned to view one of three types of images: fit ideal only, body transformation, or travel (control). Participants then completed measures of appearance comparison and body satisfaction. Viewing fit ideal only and body transformation imagery was associated with lower body satisfaction and higher appearance comparison. The relation between image type and changes in body satisfaction was mediated by appearance comparison. Findings suggest that individuals may benefit from limiting exposure to fit ideal and body transformation imagery, particularly if they are vulnerable to engaging in appearance comparison.

Pilot feasibility and acceptability trial of BE REAL's BodyKind: A universal school-based body image intervention for adolescents

Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15-18 years (M=16.24, SD=.96) from a low-income, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.

Protocol of a cluster randomised trial of BodyKind: a school-based body image programme for adolescents

BACKGROUND

Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context.

METHODS

We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up.

CONCLUSION

This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools.

TRIAL REGISTRATION

The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993 .

Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum

To aid in more targeted eating disorder (ED) prevention efforts, we sought to identify sociodemographic and weight-related risk factors for identified triggers for the onset of anorexia nervosa (AN) in youth. We conducted a retrospective chart review of youth admitted for medical treatment of AN between January 2015 and February 2020. From multidisciplinary admission notes, we extracted patient-reported reasons for diet/exercise changes. We used qualitative thematic analysis to identify ED triggers, then categorized each trigger as binary variables (presence/absence) for logistic regression analysis of risks associated with each trigger. Of 150 patients, mean (SD) age was 14.1(2.3) years. A total of 129 (86%) were female and 120 (80%) were Non-Hispanic White. Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%). Younger age was associated with higher odds of weight-related teasing (p = .04) and health education (p = .03). Males had greater odds of internalized thin/fit ideal than females (p = .04). Those with premorbid body mass indices ≥85th percentile for age and sex had greater odds of reporting positive reinforcement (p = .03) and weight-related teasing (p = .04) than those with weights <85th percentile. We use these findings to detail potential targets for advancing ED prevention efforts.

Smartphone and Instagram use, body dissatisfaction, and eating disorders: investigating the associations using self-report and tracked data

BACKGROUND

Previous research has linked smartphone and Instagram use to higher body dissatisfaction (BD) as well as eating disorder (ED) symptomatology. However, these studies have typically been limited to using self-report measures for technology use which, as shown by scientific literature, might not be reliable. In the present work, we combine self-reported assessments as well as tracked smartphone and Instagram use.

METHODS

The effective sample comprised N = 119 women (34 with ED diagnosis history) who were queried about BD and ED symptomatology, and who provided the data about their smartphone and Instagram use duration for each day of the previous week.

RESULTS

The study results show that women with an ED diagnosis history scored higher on both BD as well as ED scales. Although women with an ED diagnosis history had higher smartphone screen time, there were no statistically significant differences in Instagram screen time. Tracked smartphone use duration was positively correlated with both BD and ED symptomatology, but the role of Instagram use needs to be further elucidated.

CONCLUSIONS

The results of this study show that while BD and ED symptomatology are correlated with smartphone use, it may be that Instagram use is not the main contributor to that relationship.

Gay Dating Apps Usage, Body Dissatisfaction, and Disordered Eating in Chinese Young Gay Men

There is a paucity of research on the links between gay dating apps usage and body dissatisfaction and disordered eating, especially for muscularity dissatisfaction and muscularity-oriented disordered eating in non-Western contexts. Thus, this study aimed to evaluate the associations between gay dating apps usage, body image inflexibility, body dissatisfaction, and disordered eating with the inclusion of both body fat and muscularity dissatisfaction and both thinness-and muscularity-oriented disordered eating in a sample of Chinese young gay men. A total of 247 Chinese young gay men (mean age: 21.92 ± 2.74 years) were recruited. Gay dating apps usage, body fat dissatisfaction, muscularity dissatisfaction, body image inflexibility, and thinness-and muscularity-oriented disordered eating were evaluated. Pearson correlation and mediation analyses were conducted. Gay dating apps usage was positively correlated with body fat dissatisfaction (r = .20, p = .002), muscularity dissatisfaction (r = .17, p = .006), thinness-oriented disordered eating (r = .21, p < .001), and muscularity-oriented disordered eating (r = .29, p < .001), and these relationships could be mediated by body image inflexibility. Findings support technologically-informed prevention and intervention strategies for eating and body image disturbances in gay men in the Chinese context.

Spanish validation of two social media appearance-related constructs associated with disordered eating in adolescents: The Appearance-related Social Media Consciousness scale (ASMC) and the Critical Thinking about Media Messages scale (CTMM)

Appearance-related constructs underlying social media are negatively associated with mental health. However, their impact on the Spanish population is still unexplored. The present study aimed to validate the Spanish versions of two appearance-related scales: (1) the appearance-related social media consciousness (ASMC) scale; and (2) the critical thinking about media messages (CTMM) scale. Translation and cultural adaptation of the scales were carried out. The scales' psychometric properties were assessed using exploratory and confirmatory factor analyses, measurement invariance across gender (boys vs. girls) and age groups (early adolescents vs. middle adolescents), internal consistency, and convergent validity. The sample included 803 Spanish secondary school adolescents aged between 12 and 18 (M_age = 15.1, 47.9% girls, 47.2% boys, 4.9% non-binary gender/others). The exploratory factor analyses replicated original one-factor structures of both scales, which was verified using confirmatory factor analysis. Regarding the ASMC Scale, a re-specified model (allowing for error correlations between Items 1-2) presented an adequate fit. Both models were invariant across gender and age groups. Excellent internal consistency was found. Bivariate correlations between the ASMC and eating disorders related variables (body esteem, disordered eating, self-esteem, sociocultural attitudes towards appearance, and general mental health) supported its convergent validity and proved ASMC to be a potential target for future preventive eating disorder interventions. However, the CTMM scale correlated only with sociocultural pressures, thus, further research is needed to assess the validity of the CTMM in Spanish samples.

The role of mothers' involvement in their daughters' self-esteem and dieting behaviors

This study presents an initial effort to develop disordered eating pathology (DEP) prevention program with an emphasis on maternal involvement. Disordered eating pathology representing a range of behaviors and attitudes, from negative body image to full-blown eating disorder. It appears mainly in adolescent females and related to psychological and familial factors, including maternal modeling of thinness. A sample of 118 Israeli girls (11-12) was divided into three groups: participants in the program in parallel with their mothers, participants without their mothers, and control. Participants completed self-report questionnaires. Groups were tested three times: pre-intervention, post-intervention, and follow-up. For those girls who participated in parallel with their mothers, higher self-esteem was associated with fewer pathological diet behaviors. Findings deepen understanding of the risk factors involved in the development of DEP. The main study contribution is the important role mothers play in preventing DEP among their daughters.

The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people

Background

Eating disorders are a group of heterogenous, disabling and deadly psychiatric illnesses with a plethora of associated health consequences. Exploratory research suggests that social media usage may be triggering body image concerns and heightening eating disorder pathology amongst young people, but the topic is under-researched as a global public health issue.

Aim

To systematically map out and critically review the existing global literature on the relationship between social media usage, body image and eating disorders in young people aged 10–24 years.

Methods

A systematic search of MEDLINE, PyscINFO and Web of Science for research on social media use and body image concerns / disordered eating outcomes published between January 2016 and July 2021. Results on exposures (social media usage), outcomes (body image, eating disorders, disordered eating), mediators and moderators were synthesised using an integrated theoretical framework of the influence of internet use on body image concerns and eating pathology.

Results

Evidence from 50 studies in 17 countries indicates that social media usage leads to body image concerns, eating disorders/disordered eating and poor mental health via the mediating pathways of social comparison, thin / fit ideal internalisation, and self-objectification. Specific exposures (social media trends, pro-eating disorder content, appearance focused platforms and investment in photos) and moderators (high BMI, female gender, and pre-existing body image concerns) strengthen the relationship, while other moderators (high social media literacy and body appreciation) are protective, hinting at a ‘self-perpetuating cycle of risk’.

Conclusion

Social media usage is a plausible risk factor for the development of eating disorders. Research from Asia suggests that the association is not unique to traditionally western cultures. Based on scale of social media usage amongst young people, this issue is worthy of attention as an emerging global public health issue.

Prevention and early intervention in eating disorders: findings from a rapid review

BACKGROUND

Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs.

METHODS

This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review.

RESULTS

In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist.

CONCLUSIONS

Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

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

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

Negative comments and social media: How cognitive biases relate to body image concerns

Body image concern (BIC) is a prevalent issue thought to be exacerbated by social media. In addition to sociocultural factors, cognitive biases may also contribute to BIC. We explore whether cognitive biases in memory for body image-related words, presented in a mock social-media context, are associated with BIC in young adult women. A sample of 150 University students was presented with a series of body image-related comments aimed at either themselves, a close friend, or a celebrity in a recognisable social media context. Afterwards, a surprise memory task was completed that assessed the participant's memory for body image-related words (item memory), their insight (metamemory), and to whom a specific word was directed (source memory). Self-referential biases were identified for both item memory and source memory. Individuals with greater BIC displayed a greater self-referential bias for correctly and incorrectly sourcing negative words to themselves compared with both friend and celebrity. A greater self-referential effect in metacognitive sensitivity was also associated with higher BIC. We provide novel evidence for a cognitive bias in sourcing negative body image-related information to the self in individuals with higher BIC. The results should inform cognitive remediation programmes aimed at treating individuals with body and eating-related disorders.

Weight-related Self-monitoring App Use Among Emerging Adults is Cross-sectionally Associated With Amount and Type of Physical Activity and Screen Time

Weight-related self-monitoring (WRSM) apps are often used by emerging adults to assist in behavior change. However, little is known about the relationship between WRSM among the general population of emerging adults and various physical activity and screen time behaviors. This paper examines associations between WRSM app use and various forms of physical activity and screen time among a population-based sample of emerging adults. Data come from EAT 2018 (N = 1,568, mean age = 22.0 ± 2.0 years), a population-based sample of emerging adults from Minneapolis/St. Paul, Minnesota. Participants reported on the types of WRSM apps used (physical activity and/or dietary focused), in addition to how much time they spent doing physical activity, whether they practiced yoga, compulsive exercise, recreational screen time, social media use, and whether they viewed dieting/weight loss materials. Linear and logistic regressions were used to assess adjusted means and prevalences of outcomes. We found that physical activity-focused WRSM app users engaged in more hours of total (8.7 vs 7.2, P < .001), and moderate-to-vigorous (5.1 vs 4.3, P = .002) physical activity compared to non-users. Similar results were found for dietary WRSM app users compared to non-users. However, WRSM app users had higher levels of compulsive exercise and were more likely to view dieting/weight loss materials (Ps < .001). Findings suggest that although physical activity is higher among WRSM users, the types of physical activity and screen time behaviors WRSM users are engaging in may be harmful.

The neural correlates of socio-cognitive factors and eating disorders in young people: A systematic review

BACKGROUND

Although the primary aetiology of Eating Disorders (ED) remains unknown, research suggests a complex interplay of biological, psychological, and cultural/environmental factors. This paper aims to systematically review the literature on neuroimaging studies that measure socio-cognitive factors, in the context of body dissatisfaction and EDs in young people. Specifically, our aim was to identify patterns in the findings linked to social media-type behaviours.

METHODS

The review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. 799 papers were identified in the database search and 38 studies were selected based on exclusion and inclusion criteria. Selected studies were assessed using the National Institute of Health study quality assessment tool.

RESULTS

Findings point to state-related impairments in inhibitory control and salient emotional processing. Anorexia Nervosa(AN) showed impaired set-shifting abilities, working memory and decision making, while altered activation in attention networks and associated difficulties with conflict resolution were seen for Bulimia Nervosa(BN) and Other Specified Feeding and Eating Disorders(OSFED). AN and BN also demonstrated altered sensitivity to food-related stimuli in striatal regions, suggesting aberrant top-down emotional-cognitive control. ED participants also show deficits in body representation, impaired control over social behaviours and altered integration of visual and body perception.

DISCUSSION

These findings support the notion that socio-cognitive dysfunctions in ED are underpinned by a distributed network of structural and functional brain changes which influence the way young people with ED interact with and respond to social media, and ultimately places at them at increased risk for body image disturbances. This Review was registered with the PROSPERO International Register of Systematic Reviews, Registration number CRD42021270696.

"Intermission!" A short-term social media fast reduces self-objectification among pre-teen and teen dancers

Social media use is pervasive among youth and is associated with body image disturbance and self-objectification. The present study investigated whether a 3-day social media fast in a sample for whom social media is especially salient, female adolescent dancers, can mitigate such negative effects. Through an online survey, 65 pre-teen and teen girls, aged 10-19, completed measures of self-objectification (body surveillance and body shame), self-esteem and self-compassion both prior to and following three days of abstaining from all social media. During the fast, girls reflected on their experiences in group messages on the messaging app, WhatsApp. Overall, the fast had positive effects on participants, for whom body surveillance and body shame was significantly reduced after the fast. Self-compassion significantly mediated the change in both body surveillance and body shame, and self-esteem was a significant mediator of improvements in body shame. The content of girls' group messages revealed a number of themes, such as more positive mental states during the fast. Future research should continue to examine the potential of brief social media fasts as a means to alleviate appearance pressures adolescent girls face on these platforms in daily life.

"Eat clean, train mean, get lean": Body image and health behaviours of women who engage with fitspiration and clean eating imagery on Instagram

The present study examined the relationship between posting or viewing fitspiration and clean eating imagery in relation to body image, disordered eating, and compulsive exercise among women. Participants (269 women aged 18-30 years) who posted and/or viewed fitspiration, clean eating or travel imagery on Instagram completed an online cross-sectional questionnaire. Results showed engaging with fitspiration and clean eating material (either posting or viewing) was significantly positively associated with increased levels of compulsive exercise and athletic-ideal internalization. However, only viewing (not posting) fitspiration and clean eating content was significantly related to thin-ideal internalization and disordered eating symptomatology. Athletic-ideal internalization mediated the relationships between posting fitspiration/clean eating and disordered eating symptomatology and compulsive exercise. Both thin-ideal internalization and athletic-ideal internalization mediated the relationship between viewing fitspiration/clean eating material and disordered eating and compulsive exercise. Overall, the findings suggest that viewing fitspiration and clean eating content on Instagram is negatively associated with thin-ideal internalization and disordered eating symptomatology, however the same relationships do not exist for people who frequently post these types of material. The mediational pathways provide a nuanced understanding of how engaging with fitspiration and clean eating material on social media influences female users' body image and health behaviour.

Targeting the link between social media and eating disorder risk: A randomized controlled pilot study

OBJECTIVE

Evaluate the feasibility, acceptability, and preliminary efficacy of a self-criticism intervention addressing the link between appearance-motivated social media use and eating disorder risk. Another condition, designed to help users curate their social media feed to reduce negative impacts on wellbeing, was also trialed as an active and credible comparison.

METHOD

University students aged 17-25 (N = 170) were screened and randomized (n = 130) to the self-criticism intervention, social media curation, or waitlist control group. The intervention comprised self-guided cognitive behavior therapy delivered in four modules over 1 week. Primary outcomes were feasibility and acceptability. Secondary outcomes were appearance motivations for social media use, appearance comparison, self-criticism, body image flexibility, and disordered eating (at baseline, one-week postrandomization, and two-weeks postrandomization).

TRIAL REGISTRATION

ACTRN12621000353897.

RESULTS

Participants completed an average of 82% of the intervention modules and 77% of the homework exercises within the week allocated. The intervention was well-accepted; participants reported a range of positive aspects, alongside suggested modifications to the intervention and study design to improve acceptability. Group by time interactions suggested groups changed at a different rate on three secondary outcomes; between-groups effect sizes suggested this was due to greater improvements in the self-criticism group than waitlist control.

DISCUSSION

This was the first study to evaluate an intervention for the link between appearance-related social media use and eating disorder risk for young adults. Positive findings relating to feasibility, acceptability, and preliminary efficacy suggest a larger randomized controlled trial, with modifications to the intervention and study design, is warranted.

PUBLIC SIGNIFICANCE

Appearance-related social media use has been linked to poorer body image and disordered eating, necessitating treatments that can disrupt this relationship. The self-criticism intervention evaluated in this study shows promise as a strategy to address this need. It is the first intervention focused on appearance-related social media use to be designed for and tested in young adults, who are at heightened risk of developing an eating disorder.

Understanding Social Media Literacy: A Systematic Review of the Concept and Its Competences

Nowadays, people spend long periods on social media, ignoring the implications this carries in daily life. In this context, the concept of social media literacy, an emerging concept scarcely developed in the literature, is relevant. This study sought to analyze, descriptively, the main definitions and competences of the concept of social media literacy. The methodology included a systematic search of literature in the databases Web of Science, PubMed, and Scopus between 2010 and 2021, applying filters for English and Spanish, including only scientific articles. A total of 1093 articles were obtained. An article selection process took place, applying the inclusion and exclusion criteria, resulting in a total of 15 articles being selected. The findings indicate that the concept of social media literacy is based on media literacy to then integrate the characteristics and the implications of digital platforms. This is linked to the development of cognitive competences, where critical thinking, socio-emotional competences, and technical competences are fundamental, considering the social context. The development of socio-emotional competences stands out since social media are a frequent place of interaction between people.

Effects of the COVID-19 Restrictions on Eating Behaviour and Eating Disorder Symptomology in Female Adolescents

Confinement due to the COVID-19 pandemic imposes a burden on adolescents worldwide and may seriously impact patients with an eating disorder (ED). The current FRanconian Anorexia Nervosa during COVID-19 (FRANCO) study explored (1) perceived change of depressive and ED symptomology during lockdown, (2) the role of social media, and (3) coping strategies of anorexia nervosa (AN) patients and clinical as well as healthy comparison groups. From June 2021 to September 2021, 222 female adolescents (19 with AN, 20 with depression, 45 with a self-reported psychiatric disorder (SRPD), and 138 controls) aged 11.2 to 18.9 years completed a one-time anonymous survey retrospectively reporting back on ED and depressive symptomology before and during the pandemic, the impact of social media, and coping strategies. A reduced quality of life (QoL) due to confinement was observed in almost half of female adolescents. All groups reported a significant perceived increase of disordered eating, overeating, anxiety, and depressive symptoms and emotion-regulation problems. In AN patients, significantly higher percentual deterioration of disordered eating and anxiety and depressive symptoms was found. For controls, a younger age and higher susceptibility of the sociocultural body image significantly correlated with increased disordered eating. Large-scale media literacy interventions are recommended.

The dangers of the rabbit hole: Reflections on social media as a portal into a distorted world of edited bodies and eating disorder risk and the role of algorithms

The relationship between social media usage and body image has been well-established in the literature; however, social media companies' use of algorithms may intensify this association, as algorithms provide viewers with personalized content that is often more extreme, less monitored, and designed to keep users engaged for longer periods of time. This article details the recent media coverage of algorithms, revelations by former social media employees regarding the problematic usage of algorithms, and revelations that social media companies are aware of the harm posed by their implementation of algorithms, particularly for young, vulnerable users. We provide recommendations for influencers, educators, researchers, clinicians, parents, and users, and conclude that it is ultimately the responsibility of the social media corporations to protect and enhance the well-being of their users.

Digital modification and body image on social media: Disclaimer labels, captions, hashtags, and comments

Social media have become a major part of contemporary life. They are also a potent source of idealized and unrealistic imagery. Contributing to the lack of realism is the ability to digitally modify photos by applying a filter or editing software. One strategy suggested to counteract the negative consequences of idealized imagery on body image is the addition of a disclaimer label informing the viewer when an image has been digitally altered. The present paper brings together and presents an overview of the existing research on the consequences for body image of digital manipulation and the addition of disclaimers in a variety of types to images on social media. It concludes that disclaimers are an ineffective means of protecting body satisfaction against exposure to idealized social media images. Based on the overview, nine avenues for future research are identified.

Incorporating social media and muscular ideal internalization into the tripartite influence model of body image: Towards a modern understanding of adolescent girls' body dissatisfaction

The tripartite influence model stipulates that appearance pressures from three sources (family, peers, traditional media) lead adolescent girls to internalize a thin appearance ideal and engage in social appearance comparisons, resulting in body dissatisfaction (Thompson et al., 1999). Social media is a modern source of appearance pressure and, increasingly, adolescent girls desire an appearance that is both thin and muscular. The current study of U.S. adolescent girls (n = 543, M_age = 15.58, 49.17% Latina, 28.18% White, 8.66% Black, 7.55% Asian, 6.45% multiracial/another race/ethnicity) incorporates social media appearance pressures and muscular ideal internalization into the tripartite influence model using structural equation modeling. Findings provided support for this adapted model: family, peers, traditional media, and social media contributed to body dissatisfaction. All appearance pressure sources were associated with appearance esteem via thin ideal internalization. Peer and social media pressures were both related to greater muscular ideal internalization, which was not significantly associated with appearance esteem. Social media was the only source of pressure associated with appearance esteem through both thin ideal internalization and body comparison. Findings highlight adolescent girls' pressure to look both thin and muscular, as well as the role of social media as a prominent source of appearance socialization.

Training Resources Targeting Social Media Skills to Inform Rehabilitation for People Who Have an Acquired Brain Injury: Scoping Review

BACKGROUND

In 2020 and 2021, people increasingly used the internet to connect socially and professionally. However, people with an acquired brain injury (ABI) experience challenges in using social media, and rehabilitation professionals have reported feeling underprepared to support them in its use. To date, no review of social media skills training to inform ABI rehabilitation has been conducted.

OBJECTIVE

This scoping review aimed to examine research on interventions addressing social media skills and safety, with a focus on people living with health conditions; free web-based resources for the general public on social media skills training; and currently available online support groups for people with ABI.

METHODS

An integrative scoping review was conducted, with a systematic search strategy applied in March and November 2020 across OvidSP (MEDLINE, AMED, PsycINFO, and Embase), Scopus, Web of Science, CINAHL, Google Scholar, Google, and Facebook. The data collected were critically appraised and synthesized to describe the key content and features of social media training resources.

RESULTS

This review identified 47 peer-reviewed academic articles, 48 social media training websites, and 120 online support groups for people with ABI. A key recommendation was interactive training with practical components addressing cybersafety, how to use platforms, and how to connect with others. However, no social media training resources that were relevant and accessible for people with ABI were identified.

CONCLUSIONS

Training resources to support people with ABI in safely using social media are limited. The key content to be addressed and the features to be incorporated into web-based social media training were determined, including the need for interactive training that is co-designed and safe and incorporates practical components that support people with ABI. These findings can be used to inform the development of web-based evidence-based support for people with ABI who may be vulnerable when participating in social media.

"My critical filter buffers your app filter": Social media literacy as a protective factor for body image

Exposure to idealized appearance images on social media is recognized as having a damaging effect on body image. Identifying and harnessing protective factors are, therefore, important research foci. Building on traditional media literacy concepts, one proposed protective factor is social media literacy, that is, the application of a critical analysis of motivations behind social media posts and the constructed, generally unrealistic nature of images, when viewing appearance-focused images on social media. This article describes theoretical models of social media literacy and current measurement approaches. In addition, it examines empirical support for a protective role for social media literacy, before considering directions for future research. It was concluded that, although there is still much that needs to be understood, there is modest preliminary support for a protective role for social media literacy, especially in girls and young women.

Love me Tinder: The effects of women's lifetime dating app use on daily body dissatisfaction, disordered eating urges, and negative mood

Dating apps may potentially serve as an environment that subjects young women to the harmful effects of appearance-related pressure. The current study assessed for the first time whether women's dating app use predicted body dissatisfaction (BD), urges to engage in disordered eating (DE), and negative mood in daily life. We also examined the unique effects of women's dating app partner preferences (i.e., seeking idealised versus non-idealised physical characteristics) on the aforementioned outcomes, and whether appearance-based rejection sensitivity (appearance-RS) moderated the effects of dating app use. Participants (N = 296; 100% women) first completed a baseline survey assessing lifetime dating app usage (i.e., current or former usage), partner preferences, and appearance-RS, followed by a 7-day smartphone-facilitated ecological investigation into momentary experiences of BD, DE urges (i.e., binge-eating/purging, dietary restraint, and exercise), and negative mood. Ninety-four women (32%) reported lifetime dating app usage, which, relative to non-use, predicted greater daily urges for binge-eating/purging and negative mood. However, appearance-RS failed to moderate these effects. Among dating app users, partner preferences were not a significant predictor of the central outcomes. These findings extend previous research by examining the unique effects of dating app use on everyday BD, DE urges, and negative mood. Replication and extension are encouraged.

An examination of the factor structure of the Goldfarb Fear of Fat Scale in clinical and non-clinical samples of Polish women

Although associations between fear of fat and eating disorders (ED) have been frequently studied, it appears that the construct of fear of fat requires in-depth understanding to determine whether it is similar in individuals diagnosed with bulimia nervosa, anorexia nervosa, and individuals from the general population. The purpose of our study was to confirm the factor structure of the Goldfarb Fear of Fat Scale (GFFS) in clinical and non-clinical settings. This issue has not yet been investigated in the literature. Data were collected from 126 female patients diagnosed with ED and a total of 581 women from the general population. Our findings are highly consistent with the original single-factor structure of GFFS but only in the clinical sample. In the non-clinical sample, a good fit to the data has been achieved with a two-factor model composed of Fear of gaining weight and Fear of losing control over eating/weight. The Polish version of GFFS demonstrated good psychometric properties. It can be used as a fast screening tool to identify individuals with eating disorders and those at risk of developing such disorders. We recommend the two-factor model for non-clinical samples and the one-dimensional model for clinical samples for both research and practice.

Instagram Use and Body Dissatisfaction: The Mediating Role of Upward Social Comparison with Peers and Influencers among Young Females

BACKGROUND

Instagram is one of the most popular social media platforms among young females. Idealized body images shared on the platform have been associated with lower levels of body satisfaction in this population, likely due to social comparison processes. In the present study, we tested a mediation model linking Instagram use (i.e., browsing through others' profiles, commenting on others' looks, posting one's own photos or stories) to body dissatisfaction (i.e., body image discrepancy and lack of body appreciation), mediated by upward social comparison with close peers, distant peers, and social media influencers.

METHODS

We applied structural equation modeling to self-report cross-sectional data collected from 291 female adolescents and young women (M_age = 19.8, SD = 4.6; 94.8% Italian).

RESULTS

Our final model results show that browsing on Instagram was associated with lower levels of body appreciation, fully mediated by upward social comparison with social media influencers, not close or distant peers. Commenting on others' looks and posting own content were not associated with body dissatisfaction. Being an adolescent female (compared to a young woman) and having a higher BMI were associated with worse body appreciation.

CONCLUSIONS

Our findings highlight the need for public health interventions to raise awareness about the posting practices of social media influencers and to strengthen a positive body image among young females susceptible to social comparison processes.

Adolescent Eating Disorder Risk and the Social Online World: An Update

The role of traditional media (television and magazines) in creating eating disorder risk has long been a topic of discussion and research, but the proliferation of social media and rapid increase in the use of the Internet by adolescents generates new dynamics and new risks for the development and maintenance of eating disorders. Recent research describes the relationship between Internet and social media use and eating disorders risk, with the greatest associations found among youth with high levels of engagement and investment in photo-based activities and platforms. Here, we review different types of online content and how they are relevant to eating disorders and consider the theoretical frameworks predicting relationships between Internet and social media and eating disorders, before examining the empirical evidence for the risks posed by the online content in the development and maintenance of eating disorders. We describe proeating disorder content specifically and examine the research related to it; we then consider the implications of such content, highlight directions for future research, and discuss possible prevention and intervention strategies.

Internet addiction in young adults: The role of impulsivity and codependency

Excessive Internet use has demonstrated comorbidity with other psychological symptoms and psychiatric disorders, as well as impairments in the management of daily life, relationships and emotional stability. Recent findings in the literature have consistently supported the relationship between impulsivity and Internet addiction. The present study hypothesized that, in addition to impulsivity, a further predictor of Internet addiction might be relational co-dependency, which is also associated in the literature with addiction phenomena, but mainly substance addiction. This paper investigates the role and predictive weight of impulsivity and codependency on Internet addiction on a sample of young adult university students (n = 481) by using a hierarchical regression analysis. The participants were administered the UADI-2, the BIS-11 and the SFCDS. In terms of percentage distribution, 38 % of the participants were in the dependency range, while 37.7 % demonstrated Internet abuse behavior. The results confirmed the role of impulsiveness (β = 0.312) and added to the literature by showing the significant role of relational codependency (β = 0.275), gender (β = 0.174) and age (β = 0.196). Thus, male participants were more dependent, more impulsive and more co-dependent, with increasing age in the given range (18-30). The present study shed light to the presence of this issue among young adults and that, as a preventive and restraining measure, there is a need not only for targeted awareness-raising programmes but also for interventions to promote greater emotional control and a more balanced management of personal relationships.

School-Based Interventions Improve Body Image and Media Literacy in Youth: A Systematic Review and Meta-Analysis

Body ideals conveyed by the media and by body comparisons often result in body dissatisfaction, which can cause risky health behaviours and eating disorders, especially in adolescents. We conducted a meta-analytic review of existing school-based interventions designed to enhance media literacy in order to reduce body dissatisfaction and to promote a positive body image. We included controlled trials examining children and adolescents from grade five to nine (age 10-15 years) after a manual search and a comprehensive literature search using PsycINFO, Medline, Web of Science, and CENTRAL. We computed average weighted effect sizes (Hedges' g) with the help of a random effects model and identified seventeen different programme evaluations with 7392 participants. We found a significantly larger effect on positive body image and media literacy in the intervention compared to control groups. However, heterogeneity was substantial for both outcomes. Results suggest that media literacy interventions have the potential to improve media literacy and reduce body dissatisfaction. Interventions that worked with the principle of induction of cognitive dissonance were the most effective.

Photo manipulation as a predictor of facial dissatisfaction and cosmetic procedure attitudes

Photo manipulation (editing photos prior to sharing them) has become increasingly popular on social media. While intended to enhance a photo's quality, this behaviour has been linked to heightened body image concerns. The present study investigated whether social media photo manipulation predicts facial dissatisfaction, attitudes towards cosmetic procedures, and intentions to undergo facial cosmetic procedures in young women, and the moderating role of self-discrepancy therein. Australian women (N = 227, 17-25 years) completed an online cross-sectional questionnaire. Social media photo manipulation was associated with greater facial dissatisfaction, cosmetic procedure attitudes/intentions, and appearance-based self-discrepancy. Photo manipulation was a significant predictor of cosmetic procedure attitudes and intentions, but not of facial dissatisfaction. Appearance-based self-discrepancy significantly moderated the relationship between photo manipulation and facial dissatisfaction, whereby the relationship between photo manipulation and facial dissatisfaction was stronger for those with lower self-discrepancy. Results highlight a key role for photo manipulation and appearance-based self-discrepancies in relation to facial dissatisfaction for young women. They also provide insight into predictors of cosmetic procedure intentions and attitudes. This signals a pressing need to develop effective intervention and prevention programs to help young women limit their appearance-based photo manipulation behaviours for use on social media.

The Effects of Reducing Social Media Use on Body Esteem Among Transitional-Aged Youth

Introduction. Social media use (SMU) and body image concerns are highly prevalent in youth. Although several studies have shown that high SMU is crosssectionally associated with lower body esteem, experimental evidence is lacking. This pilot study experimentally evaluated the effects of reducing SMU on body esteem among transitional aged youth (TAY) with emotional distress. Methods. Thirty-eight undergraduate students presenting with elevated symptoms of anxiety/depression were randomly assigned to the intervention (n = 16), where SMU was restricted to 60 minutes/day, or to the control group (n = 22), where SMU was not restricted. SMU was monitored via screen-time trackers in participants’ smartphone submitted daily during baseline (1-week) and intervention (3-week) periods. Baseline and post-intervention measurements were taken to assess appearance and weight esteem as well as symptoms of anxiety and depression as secondary outcomes. Results. A significant group × time interaction emerged indicating that the intervention participants showed a significantly greater increase in appearance esteem over the 4 weeks compared to controls. There was no significant between-group difference on change in weight esteem. A significant group × time interaction emerge on anxiety indicating that intervention participants showed a significantly greater improvement in anxiety over the study period compared to controls. There was no significant between-group difference on change in depressive symptoms. Discussion. Reducing SMU may be a feasible and effective method of improving appearance esteem and reducing anxiety in a high-risk population of TAY with emotional distress; however, more high-quality randomized controlled trials are needed to confirm findings.

Social media, body image, and the question of causation: Meta-analyses of experimental and longitudinal evidence

This article presents four meta-analyses that can inform causality in the relationship between social media and body image; 24 experimental samples comparing the effect of appearance-ideal social media images to non-appearance-related conditions (n = 3816); 21 experimental samples examining the effect of contextual features (e.g., comments and captions) accompanying appearance-ideal social media images (n = 3482); 14 experimental samples investigating the effect of appearance-ideal images versus other appearance images on social media (n = 2641); and 10 longitudinal samples on social media use and body image (n = 5177). Social media appearance-ideal images had a moderate negative effect on body image (Hedges' g = -0.61, p < .01), were more damaging in higher- than lower-risk contexts (Hedges' g = -0.12, p < .01), and were moderately more impactful than other social media appearance images (Hedges' g = -0.68, p = .05). These effects were smaller but significant with outliers removed. Social media use had a very small, negative correlation with body image longitudinally (Fisher's Z = -0.08, p < .001). No significant moderators emerged. Clinicians should consider approaches to managing social media use, particularly exposure to appearance-ideal imagery, in case conceptualisation and psychoeducation for clients at risk of, or experiencing, body image disturbance.

Outcomes of a Cluster Randomized Controlled Trial of the SoMe Social Media Literacy Program for Improving Body Image-Related Outcomes in Adolescent Boys and Girls

Although the negative effect of social media use among youth on body image and eating concerns has been established, few classroom-based resources that can decrease these effects through targeting social media literacy skills have been developed. This study aimed to test the efficacy of SoMe, a social media literacy body image, dieting, and wellbeing program for adolescents, through a cluster randomized controlled trial. Participants (n = 892; M_age = 12.77, SD = 0.74; range 11–15; 49.5% male) were randomized by school (n = 8) to receive either weekly SoMe (n = 483) or control sessions (lessons as usual; n = 409) over 4 weeks in their classroom. Participants completed surveys at four timepoints (baseline, 1-week post-intervention, and 6- and 12-month follow-up) assessing body dissatisfaction, dietary restraint, strategies to increase muscles (primary outcomes), self-esteem and depressive symptoms (secondary outcomes), and internalization of appearance ideals and appearance comparison (exploratory outcomes). Modest positive intervention effects were found in dietary restraint and depressive symptoms at 6-month follow-up in girls but few positive effects emerged for boys. The findings provide only preliminary support for a social media literacy intervention, but suggest the usefulness of both identifying those who benefit most from a universally delivered intervention and the need to refine the intervention to maximize intervention effects.

Invited Response on: "Letter to the Editor: Predictors of Acceptance of Cosmetic Surgery- Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction Among Women"

This response letter highlights the importance for cosmetic surgeons to take a psychosocial perspective, considering the role of social media influences on the acceptance of cosmetic surgery in young women. Furthermore, through this article we have provided a brief overview of possible interventions useful to prevent the negative influences that social media can have on body image and the acceptance of procedures aimed at modifying one's body for purely aesthetic reasons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The role of weight- and appearance-related discrimination on eating disorder symptoms among adolescents and emerging adults

BACKGROUND

Eating disorder symptoms (EDs) have been discussed as a prominent problem among late adolescent girls with serious health risks and long-term consequences. However, there is a lack of population-based evidence on EDs comprising the age range from early adolescence to emerging adulthood as well as considering both females and males equally. Additionally, the differential role of a comprehensive set of several relevant risk factors and particularly weight- and appearance-related discrimination warrants further attention. Thus, we aimed to contribute to a better understanding of sex- and age-related differences in associations between discrimination experience and other relevant personal risk factors (body image, social media use, self-efficacy, social support) with EDs. Furthermore, we were interested in the exploration of underlying mechanisms enhancing the risk of EDs by taking discrimination experience into account.

METHODS

Based on a logistic regression model, we investigated associations between weight- and appearance-related discrimination and EDs while controlling for other relevant personal risk factors in a subsample of N = 8504 adolescents and emerging adults (54.4% female, mean age = 20.71 years, SD = 4.32 years) drawn from a German representative health survey (KiGGS Wave 2). In a second step, we investigated the mediating role of discrimination experience between the other risk factors and EDs with the help of a path model.

RESULTS

While controlling for other relevant personal risk factors, weight- and appearance-related discrimination was significantly related to EDs. Whereas the risk of EDs was significantly enhanced in males and emerging adults frequently experiencing weight-related discrimination, adolescents showed a higher risk of EDs when experiencing appearance-related discrimination. Moreover, discrimination experience partly explained the associations between body image dissatisfaction, low self-efficacy, high media use and ED symptoms.

CONCLUSIONS

The results highlight weight- and appearance-related discrimination as one central factor to be considered in the pathogeneses of EDs and underpin the need for discrimination prevention as well as the promotion of adaptive coping with discrimination experience to reduce the risk of developing ED symptoms. Males and emerging adults need particular attention when facing weight-related discrimination whereas risk constellations and EDs particularly affecting females need further investigation.

#Take idealized bodies out of the picture: A scoping review of social media content aiming to protect and promote positive body image

Much evidence has highlighted detrimental effects of social media on body image, and attention has turned towards identifying content that could support and promote positive body image. This study aimed to conduct a scoping review of the emerging evidence focused on social media content that might support positive body image. A total of n = 35 studies (21 experimental) examining social media were identified along with n = 11 studies not specifically focusing on social media but with clear implications. Overall, findings suggest that images that do not portray individuals are most helpful for body image, as well as those portraying appearances diverging from appearance ideals. Our review also identifies types of social media content that have so far not been found to protect body image, and those not sufficiently evaluated. Regarding textual captions and comments, the most promising avenue involves highlighting the contrived and unrealistic nature of social media content. However, empirical data are limited and not robust. Body acceptance-related statements have so far not been found to be helpful for body image, and findings regarding the usefulness of using social marketing strategies (such as hashtags) to identify content that may be more realistic is nascent and conflicted.

Digital Bodies: A controlled evaluation of a brief classroom-based intervention for reducing negative body image among adolescents in the digital age

BACKGROUND

A growing body of research has linked social media use to negative body image.

AIMS

The present research aimed to evaluate the efficacy of Digital Bodies, a brief classroom-based intervention that aims to improve adolescents' body image.

METHODS

British adolescents (N = 290; Age M = 12.81; SD = 0.40; Range = 12-13; Female = 151) were cluster randomized to intervention or waiting list control groups. Measures of body satisfaction, appearance ideal internalization (thin and athletic ideal internalization) and self-objectification were completed at baseline (T1), 1-week post-intervention (T2) and 8-week follow-up (T3).

RESULTS

Multi-level modelling showed adolescents in the intervention group reported improved body satisfaction at T2, in comparison to the control, and crucially this effect was sustained at T3. Additionally, girls reported less thin ideal internalization at T2 relative to the control, but this effect was not sustained at T3. No other intervention effects were found.

CONCLUSIONS

Overall, the findings provide initial support for the efficacy of Digital Bodies as an intervention for improving adolescents' body satisfaction.

Processing Body Image on Social Media: Gender Differences in Adolescent Boys' and Girls' Agency and Active Coping

Although scholars continue to debate the influence of social media on body image, increased social media use, especially engaging in appearance-related behaviors may be a potential risk factor for body dissatisfaction in adolescents. Little research has investigated how adolescents process appearance-related content and the potential strategies they use to protect body image perceptions on social media. To investigate coping strategies used by adolescents, four qualitative focus groups were conducted with 29 adolescents (23 girls) aged 15–16 years (M = 15.31, SD = 0.47) in mixed-gender Irish secondary schools. Thematic analysis revealed that adolescents employed many different behavioral strategies such as avoiding negative content and selecting positive content. Cognitive processing strategies such as critically evaluating body-related content, psychologically distancing from and positively reframing challenging content were also used, although less frequently. Boys appeared to exhibit greater positive agency over their bodies and social media use and tended to use more active coping styles than girls. Efforts to promote body image on social media such as body positive pages and exposing artificial social media content were considered limited in their effectiveness.

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

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

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

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

Body talk in the digital age: A controlled evaluation of a classroom-based intervention to reduce appearance commentary and improve body image

This research evaluates the efficacy of a classroom-based intervention - Body Talk in the Digital Age (BTIDA) - in reducing adolescents' appearance commentary and improving body image. British adolescents (N = 314; Age Range = 12-14) were cluster randomised to intervention or waiting-list control groups. Measures of appearance commentary, appearance ideal internalisation, self-objectification and body satisfaction were completed at baseline (T1), then one-week (T2) and eight-week (T3) post-intervention. Multi-level modelling showed girls who received BTIDA reported less appearance commentary engagement and thin ideal internalisation at T2 and T3, than the control, supporting the partial efficacy of BTIDA for girls. No intervention effects were found among boys.

Promoting Sexual Health in High School: A Feasibility Study of A Web-based Media Literacy Education Program

Comprehensive sexual health education (SHE) is an effective strategy for improving adolescent sexual health. However, few of these programs address media influence on sexual cognitions and behaviors. Also, more research is needed on using web-based instruction for SHE. Seventeen classes (N = 331 students) in one high school in the United States were enrolled in a pre-post randomized controlled trial to assess the feasibility of Media Aware, a web-based SHE program that uses a media literacy education (MLE) approach. Compared to a delayed-intervention group, students who received Media Aware had significant reductions in their perceived realism of and similarity to media messaging, improved cognitive elaboration of media messages, more realistic perceptions of teen sex norms and risky sex norms, increased efficacy and intention to act as a bystander to potential sexual assault, increased intent to communicate before sex, and increased efficacy to use contraception/protection. These students reported being less willing to hook up, being less willing to have unprotected sex (for males), and positive feedback on their experiences using a web-based program. This study provides evidence that web-based MLE sexual health programming is a feasible and acceptable strategy for improving media-related and sexual health outcomes among adolescents.